Healthcare Provider Details

I. General information

NPI: 1134370950
Provider Name (Legal Business Name): PROVIDENCE HEALTH & SERVICES - WASHINGTON
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/10/2008
Last Update Date: 05/06/2025
Certification Date: 05/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 W POPLAR ST
WALLA WALLA WA
99362-2846
US

IV. Provider business mailing address

PO BOX 1477
WALLA WALLA WA
99362-0312
US

V. Phone/Fax

Practice location:
  • Phone: 509-522-5720
  • Fax: 509-522-5950
Mailing address:
  • Phone: 509-522-5906
  • Fax: 509-522-5789

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QB0400X
TaxonomyBirthing Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. DONALD WAYNE ANDERSON JR.
Title or Position: ASSISTANT SECRETARY OF ENROLLMENTS
Credential:
Phone: 425-358-9786