Healthcare Provider Details

I. General information

NPI: 1457460180
Provider Name (Legal Business Name): PROVIDENCE HEALTH & SERVICES - WASHINGTON
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/29/2006
Last Update Date: 10/09/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 S SCHEUBER RD
CENTRALIA WA
98531-8877
US

IV. Provider business mailing address

909 N BROADWAY PBO/CREDENTIALING
EVERETT WA
98201-1409
US

V. Phone/Fax

Practice location:
  • Phone: 360-330-8950
  • Fax: 360-330-8955
Mailing address:
  • Phone: 425-317-0246
  • Fax: 425-317-0291

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State

VIII. Authorized Official

Name: KATHLEEN NURMI
Title or Position: DIR REVENUE CYCLE MANAGEMENT
Credential:
Phone: 360-493-4081