PROVIDENCE HEALTH & SERVICES-WA (NPI# 1033360144) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1033360144 |
| Entity Type | Organization |
| Organization Name | PROVIDENCE HEALTH & SERVICES-WA |
| Practice Address |
1321 Colby Ave Everett WA 98201-1665 |
| Mailing Address |
Po Box 3369 Portland OR 97208-3369 |
| Practice Telephone | 4252613968 |
| Practice Fax Number | 4252613967 |
| Enumeration Date | 2008-10-07 |
| Last Update Date | 2018-01-11 |
| Authorized Official Name | MR. DONALD WAYNE ANDERSON JR. (ASSIST SECRETARY-ENROLLMENT) |
| Authorized Official Telephone | 4255255392 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 363LP0808X |
Nurse Practitioner Specialization: Psych/Mental Health |
Physician Assistants & Advanced Practice Nursing Providers | ||
| Y | 2084A0401X |
Psychiatry & Neurology Specialization: Addiction Medicine |
Allopathic & Osteopathic Physicians |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1114236791 | Providence Health & Services-wa | Surgery | 1330 Rockefeller Avenue, Suite 400, Everett, WA 98201-1676 | 2010-09-30 |
| 1588294854 | Providence Health & Services-wa | Clinic/Center | 916 Pacific Ave, Everett, WA 98201-4147 | 2020-01-24 |
| 1649615220 | Providence Health & Services-wa | Naturopath | 1321 Colby Ave, Everett, WA 98201-1665 | 2013-05-08 |
| 1215225099 | Providence Health & Services-wa | Midwife | 14692 179th Ave Se, Ste 800, Monroe, WA 98272-1162 | 2011-07-14 |
| 1447547658 | Providence Health & Services-wa | Registered Nurse | 14692 179th Ave Se, Ste 800, Monroe, WA 98272-1162 | 2011-07-08 |
| 1891088845 | Providence Health & Services-wa | Pharmacy | 3305 Nassau St # 101, Everett, WA 98201-4140 | 2011-05-24 |
| 1831499755 | Providence Health & Services-wa | Orthopaedic Surgery | 1330 Rockefeller Ave, Suite 225, Everett, WA 98201-1684 | 2010-10-26 |
| 1972819175 | Providence Health & Services-wa | Registered Nurse | 3305 Nassau St, Everett, WA 98201-4140 | 2010-08-25 |
| 1164747242 | Providence Health & Services-wa | General Practice | 1717 13th Street, Everett, WA 98201-1621 | 2010-04-01 |
| 1346571841 | Providence Health & Services-wa | Nurse Practitioner | 1330 Rockefeller, Suite 200, Everett, WA 98201-1677 | 2010-01-22 |
| Entity Type | Entity Name | Entity Address |
|---|---|---|
| Virginia Business Entities | Providence Health & Services-Washington | 1801 Lind Ave Sw #9016, Renton, Washington 98057-9016 |
| Oregon Corporations, Companies and Business Names | PROVIDENCE HEALTH & SERVICES-WASHINGTON | 1801 Lind Ave Sw #9016, Renton, WA 98057 |
| System for Award Management (SAM) Entities | PROVIDENCE HEALTH & SERVICES-WASHINGTON | 1801 Lind Ave Sw #9016, Renton, WA 98057-3368 |
| Washington State Corporations | PROVIDENCE HEALTH & SERVICES-WASHINGTON | 1801 Lind Ave Sw # 9016, Renton, WA 98057 |
| Street Address |
1321 COLBY AVE |
| City | EVERETT |
| State | WA |
| Zip Code | 98201-1665 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1073519328 | Albert Dominick Pacifico II | Internal Medicine | 1321 Colby Ave, Medical Staff Office, Everett, WA 98201-1665 | 2005-06-22 |
| 1083239610 | Arianna Randolph | Social Worker | 1321 Colby Ave, Everett, WA 98201-1665 | 2020-06-09 |
| 1619527595 | Katherine Doreen Carpenter | Pharmacy Technician | 1321 Colby Ave, C-wing First Floor, Everett, WA 98201 | 2019-09-12 |
| 1396302477 | Ashley L Grieve | Nurse Practitioner | 1321 Colby Ave, Everett, WA 98201-1665 | 2019-05-23 |
| 1588140073 | Naa Afadua Annoh | Nurse Practitioner | 1321 Colby Ave, Everett, WA 98201-1665 | 2018-07-17 |
| 1386170694 | Katherine Mccusker | Nurse Practitioner | 1321 Colby Ave, Everett, WA 98201-1665 | 2017-05-05 |
| 1437602935 | Rebecca Louise Formosa | Nurse Practitioner | 1321 Colby Ave, Everett, WA 98201-1665 | 2016-08-01 |
| 1144673153 | Julie Editha Quandt | Nurse Practitioner | 1321 Colby Ave, Everett, WA 98201-1665 | 2016-07-14 |
| 1013361518 | Rhadika Mccormick Souza | Emergency Medicine | 1321 Colby Ave, Everett, WA 98201-1665 | 2016-04-20 |
| 1013379114 | Katherine Morgan | Internal Medicine | 1321 Colby Ave, Everett, WA 98201-1665 | 2016-03-28 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1306471867 | Shannon Michelle Dewald | Registered Nurse | D8s 1700 13th St, Everett, WA 98201 | 2020-03-05 |
| 1578123113 | Precious Medicial Spa, LLC | Registered Nurse | 1728 W. Marine View Dr Suite 212, Everett, WA 98201 | 2019-06-17 |
| 1508429796 | Alix Deschain | Counselor | 2801 Broadway, Everett, WA 98201 | 2019-04-15 |
| 1811457534 | Khushboo Patel | Pharmacist | 1330 Rockefeller Ave Ste 150, Everett, WA 98201 | 2019-03-20 |
| 1164991188 | Grace Talbot Davis | Registered Nurse | 2601 Summit Avenue, Bldg. C, Everett, WA 98201 | 2018-11-20 |
| 1063924603 | Tracy Sisk | Counselor | 3120 Colby Ave, 502, Everett, WA 98201 | 2017-11-03 |
| 1710403126 | Michelle Durham | Counselor | 3322 Boadway Fl 2, Everett, WA 98201 | 2017-08-17 |
| 1861927949 | Melanie Schmidt | Counselor | 2610 Westmore Ave, Everett, WA 98201 | 2017-04-26 |
| 1518413327 | Joseph Madson Dmd Pllc | Clinic/Center | 3802 Colby Ave, 4th Floor, Everett, WA 98201 | 2016-08-31 |
| 1043683162 | Jennifer Adams | Counselor | 1511 26th St, Everett, WA 98201 | 2015-11-11 |
| Find all providers in zip 98201 | ||||
| Taxonomy Code | 2084A0401X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Psychiatry & Neurology |
| Specialization | Addiction Medicine |
| A doctor of osteopathy board eligible/certified in the field of Psychiatry by the American Osteopathic Board of Neurology and Psychiatry is able to obtain a Certificate of Added Qualifications in the field of Addiction Medicine |
| Notes: Source: American Osteopathic Board of Neurology and Psychiatry, 2007 [1/1/2008: definition added, source added; 7/1/2011: modified source] - Additional Resources: http://www.osteopathic.org/certification |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1851500151 | Daniel Rutrick Md PC | Psychiatry & Neurology | 617 Broadway, Everett, MA 02149-3712 | 2007-05-22 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1811155773 | Raghuram B Bhat | Psychiatry & Neurology | 417 Ne 2nd Ave Ste 205, Camas, WA 98607 | 2008-05-28 |
| 1487863999 | Phyllis Jo Henderson | Psychiatry & Neurology | 418 S 44th Ave, Yakima, WA 98908-3303 | 2007-05-21 |
| 1205956265 | Kevin Richard Wandler | Psychiatry & Neurology | 888 S Hillhurst Rd, Ridgefield, WA 98642-9063 | 2007-03-30 |
| 1457410961 | Frederick A Montgomery Md Inc Ps | Psychiatry & Neurology | 215 So 11th # D, Yakima, WA 98902 | 2006-12-08 |
| 1962575951 | Marc D Pellicciaro | Psychiatry & Neurology | 12729 Northup Way Ste 6, Bellevue, WA 98005-1935 | 2006-11-16 |
| 1821188764 | Steven M Juergens | Psychiatry & Neurology | 11201 Se 8th St Ste 105, Bellevue, WA 98004-6420 | 2006-10-13 |
| 1225666951 | Radiant Path Psychiatry Pllc | Psychiatry & Neurology | 330 King St Ste 5, Wenatchee, WA 98801-2857 | 2020-03-30 |
| 1184101073 | Luke Rosen, Do, Pllc | Psychiatry & Neurology | 2501 Ne 134th St Ste 203, Vancouver, WA 98686-3026 | 2018-07-24 |
| 1386883726 | Seema Basnett | Psychiatry & Neurology | 10001 17th Pl S, Lower Level, Seattle, WA 98168-1615 | 2009-02-09 |
| 1093921660 | Allison Evans Gullo | Psychiatry & Neurology | 6926 Ne Fourth Plain Blvd, Vancouver, WA 98661-7369 | 2007-05-14 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.