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General NPI Number Information
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NPI Number | 1851574750
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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 | 12/13/2007
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Last Update Date | 05/15/2025
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Provider Practice Location Address
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Address Line | 413 LILLY RD NE
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City | OLYMPIA
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State | WA
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Zip | 98506-5133
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Country | US
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Telephone | 360-491-9480
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Fax |
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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 | 425-525-6717
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Fax | 425-525-6700
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Authorized Official
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Title or Position | ASSISTANT SECRETARY FOR 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 | 363AS0400X
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Taxonomy Name | Surgical Physician Assistant
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License Number |
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License Number State |
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