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General NPI Number Information
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NPI Number | 1033360144
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Entity Type | Organization
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Legal Business Name | PROVIDENCE HEALTH & SERVICES-WA
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Dates
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Enumeration Date | 10/07/2008
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Last Update Date | 05/13/2025
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Provider Practice Location Address
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Address Line | 1321 COLBY AVE
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City | EVERETT
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State | WA
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Zip | 98201-1665
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Country | US
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Telephone | 425-261-3968
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Fax | 425-261-3967
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Provider Business Mailing Address
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Address Line | PO BOX 31001-4110
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City | PASADENA
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State | CA
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Zip | 91110-4110
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | ASSIST SECRETARY-ENROLLMENT
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Name | MR. DONALD WAYNE ANDERSON JR.
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Credential |
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Telephone | 425-358-9786
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 2084A0401X
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Taxonomy Name | Addiction Medicine (Psychiatry & Neurology) Physician
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License Number |
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License Number State |
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