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General NPI Number Information
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NPI Number | 1750520516
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Entity Type | Organization
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Legal Business Name | PROVIDENCE HEALTH & SERVICES WASHINGTON
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Dates
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Enumeration Date | 02/18/2009
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Last Update Date | 05/09/2025
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Provider Practice Location Address
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Address Line | 1717 13TH STREET SUITE 300
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City | EVERETT
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State | WA
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Zip | 98201-1621
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Country | US
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Telephone | 425-297-5660
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Fax | 425-297-5505
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Provider Business Mailing Address
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Address Line | PO BOX 31001-4114
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City | PASADENA
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State | CA
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Zip | 91110-4114
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Country | US
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Telephone | 425-358-9786
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Fax |
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Authorized Official
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Title or Position | ASSISTANT SECRETARY OF ENROLLMENTS
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Name | 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 | 207VX0201X
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Taxonomy Name | Gynecologic Oncology Physician
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License Number |
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License Number State | WA
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