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General NPI Number Information
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NPI Number | 1912158023
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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 | 10/07/2008
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Last Update Date | 05/09/2025
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Provider Practice Location Address
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Address Line | 12800 BOTHELL EVERETT HWY SUITE 260
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City | EVERETT
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State | WA
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Zip | 98208-6642
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Country | US
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Telephone | 425-316-5080
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Fax | 425-316-5025
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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 | 207N00000X
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Taxonomy Name | Dermatology Physician
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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 | 207ND0101X
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Taxonomy Name | MOHS-Micrographic Surgery Physician
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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 | 207ND0900X
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Taxonomy Name | Dermatopathology Physician
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 207NP0225X
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Taxonomy Name | Pediatric Dermatology Physician
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 207NS0135X
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Taxonomy Name | Procedural Dermatology Physician
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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 | 208200000X
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Taxonomy Name | Plastic Surgery Physician
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License Number |
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License Number State |
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