Healthcare Provider Details

I. General information

NPI: 1306694732
Provider Name (Legal Business Name): PROVIDENCE HEALTH & SERVICES-WASHINGTON
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/09/2024
Last Update Date: 05/09/2024
Certification Date: 05/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1615 75TH ST SW STE 210
EVERETT WA
98203-6293
US

IV. Provider business mailing address

1801 LIND AVE SW
RENTON WA
98057-3368
US

V. Phone/Fax

Practice location:
  • Phone: 425-261-4780
  • Fax: 425-261-4720
Mailing address:
  • Phone: 425-261-4780
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License Number
License Number State

VIII. Authorized Official

Name: MS. NADINE PIERRE
Title or Position: DIRECTOR
Credential: PT
Phone: 425-261-4780