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General NPI Number Information
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NPI Number | 1790936185
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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 | 10/04/2008
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Last Update Date | 05/07/2025
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Provider Practice Location Address
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Address Line | 900 PACIFIC AVE FIRST FLOOR
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City | EVERETT
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State | WA
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Zip | 98201-4168
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Country | US
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Telephone | 425-258-7311
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Fax | 425-258-7618
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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 | ASST SECRETARY-ENROLLMENT
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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 | 133N00000X
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Taxonomy Name | Nutritionist
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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 | 133NN1002X
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Taxonomy Name | Nutrition Education Nutritionist
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 261QD1600X
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Taxonomy Name | Developmental Disabilities Clinic/Center
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License Number |
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License Number State | WA
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Taxonomy #4
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Taxonomy Code | 282N00000X
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Taxonomy Name | General Acute Care Hospital
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License Number | HAC.FS.00000084
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License Number State | WA
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Taxonomy #5
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #6
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Taxonomy Code | 363LP0200X
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Taxonomy Name | Pediatric Nurse Practitioner
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License Number |
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License Number State |
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