PROVIDENCE HEALTH & SERVICES WASHINGTON (NPI# 1851574750) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1851574750 |
| Entity Type | Organization |
| Organization Name | PROVIDENCE HEALTH & SERVICES WASHINGTON |
| Practice Address |
413 Lilly Rd Ne Olympia WA 98506-5133 |
| Mailing Address |
Po Box 3505 Portland OR 97208-3505 |
| Practice Telephone | 3604919480 |
| Mailing Telephone | 4255256717 |
| Mailing Fax Number | 4255256700 |
| Enumeration Date | 2007-12-13 |
| Last Update Date | 2017-10-31 |
| Authorized Official Name | DONALD WAYNE ANDERSON JR. (DIRECTOR REIMBURSEMENT ADMINISTRATI) |
| Authorized Official Telephone | 4255255392 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363AS0400X |
Physician Assistant Specialization: Surgical Technologist |
Physician Assistants & Advanced Practice Nursing Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| WA | L&I | 129210 | 01 |
| WA | L&I CRIME VICTIMS | 8901337 | 01 |
| WA | 7135932 | 05 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1134656135 | Providence Health & Services Washington | Clinic/Center | 1018 Capitol Way S Ste 300, Olympia, WA 98501-1212 | 2017-05-22 |
| 1023550050 | Providence Health & Services Washington | Psychologist | 225 State Ave Ne, Olympia, WA 98501-6951 | 2016-11-08 |
| 1003367863 | Providence Health & Services Washington | Radiology | 4800 College St Se Ste E, Lacey, WA 98503-4389 | 2016-10-17 |
| 1023563897 | Providence Health & Services Washington | Clinic/Center | 1705 Se Meadowbrook Blvd, Suite 2, College Place, WA 99324-1756 | 2016-08-22 |
| 1457721250 | Providence Health & Services Washington | Clinic/Center | 1200 Basich Blvd, Aberdeen, WA 98520-1035 | 2015-10-06 |
| 1902141500 | Providence Health & Services Washington | Clinical Medical Laboratory | 820 S Mcclellan St Ste Ll10, Spokane, WA 99204-2446 | 2012-12-07 |
| 1881907715 | Providence Health & Services Washington | Internal Medicine | 62 W 7th Ave, Spokane, WA 99204-2321 | 2010-07-20 |
| 1073744850 | Providence Health & Services Washington | Rehabilitation, Substance Use Disorder Unit | 2505 Olympic Hwy N., Ste 140, Shelton, WA 98584-2978 | 2009-07-28 |
| 1770714693 | Providence Health & Services Washington | Rehabilitation, Substance Use Disorder Unit | 508 1/2 Eighth Street, Hoquiam, WA 98550-3521 | 2009-07-28 |
| 1033309604 | Providence Health & Services Washington | Family Medicine | 1450 Northwest Lane Se, Lacey, WA 98503-6908 | 2007-07-30 |
| Street Address |
413 LILLY RD NE |
| City | OLYMPIA |
| State | WA |
| Zip Code | 98506-5133 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1437157674 | Michael J Menen | Internal Medicine | 413 Lilly Rd Ne, Olympia, WA 98506-5133 | 2005-07-12 |
| 1558962209 | Anieska Timms | Registered Nurse | 413 Lilly Rd Ne, Olympia, WA 98506-5133 | 2020-11-07 |
| 1134737653 | Ngoc-van Thi Tran | Speech-Language Pathologist | 413 Lilly Rd Ne, Olympia, WA 98506-5133 | 2020-07-21 |
| 1780292714 | Paola Von Oelffen | Student in an Organized Health Care Education/Training Program | 413 Lilly Rd Ne, Olympia, WA 98506-5133 | 2020-07-15 |
| 1013542885 | Raffy Jatamosa | Registered Nurse | 413 Lilly Rd Ne, Olympia, WA 98506-5133 | 2020-03-11 |
| 1811522766 | Kaman Lindgren | Registered Nurse | 413 Lilly Rd Ne, Olympia, WA 98506-5133 | 2020-03-10 |
| 1497389886 | Phuong Le | Registered Nurse | 413 Lilly Rd Ne, Olympia, WA 98506-5133 | 2020-02-25 |
| 1679107239 | Tamara Eklund | Registered Nurse | 413 Lilly Rd Ne, Olympia, WA 98506-5133 | 2020-02-23 |
| 1598307878 | Alisa Singratanakul | Pharmacist | 413 Lilly Rd Ne, Olympia, WA 98506-5133 | 2019-10-08 |
| 1528615192 | Anh Phuong Ho | Pharmacist | 413 Lilly Rd Ne, Olympia, WA 98506-5133 | 2019-08-19 |
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| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1477185460 | Chloe Harper | Technician, Other | 3443 Lilly Rd Se, Ste B, Olympia, WA 98506 | 2020-02-07 |
| 1912543539 | Jessica Marie Radakovich | Licensed Practical Nurse | 3426 Mary Elder Rd, Olympia, WA 98506 | 2019-11-19 |
| 1669014973 | Arlene Josephine Adams | Registered Nurse | 413 Lily Rd Ne, Olympia, WA 98506 | 2019-10-09 |
| 1861999120 | Debra Delores Barker | Licensed Practical Nurse | 3710 South Bay Rd Ne, Olympia, WA 98506 | 2018-04-12 |
| 1801304431 | Michelle Warner | Nurse Practitioner | 205 Lilly Rd Ne Ste A1, Olympia, WA 98506 | 2018-01-17 |
| 1396258364 | Institute for Family Development | Community/Behavioral Health | 204 Quince St. Ne, Suite 200, Olympia, WA 98506 | 2017-11-13 |
| 1083137715 | Cameron Kunkel | Specialist/Technologist | 2512 20th Ave Ne, Olympia, WA 98506 | 2017-07-25 |
| 1184144768 | Trevor Shane Kwan | Family Medicine | 525 Lilly Road Ne, Olympia, WA 98506 | 2017-06-23 |
| 1073043212 | Michael H Harburg | Behavior Technician | 3857 Martin Way Ne, Olympia, WA 98506 | 2017-06-19 |
| 1780114371 | Priscilla Kangyang Jadu | Counselor | 3857 Martin Way E., Olympia, WA 98506 | 2017-06-15 |
| Find all providers in zip 98506 | ||||
| Taxonomy Code | 363AS0400X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Physician Assistant |
| Specialization | Surgical Technologist |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1295778165 | Christopher S Johnson | Physician Assistant | 3920 Capitol Mall Drive Sw, Suite 201, Olympia, WA 98502-8700 | 2006-06-14 |
| 1740611557 | Matthew Steven Renner | Physician Assistant | 615 Lilly Rd Ne Ste 220, Olympia, WA 98506-5137 | 2013-12-03 |
| 1124144431 | Elijah Telfare | Physician Assistant | 500 Lilly Rd Ne, Suite 100, Olympia, WA 98506-5195 | 2007-03-21 |
| 1578632238 | Joshua B Mayes | Physician Assistant | 3901 Capital Mall Dr Sw, Suite A, Olympia, WA 98502-8654 | 2006-11-07 |
| 1972536779 | Lori Anne Cardwell | Physician Assistant | 615 Lilly Rd Ne, Suite 100, Olympia, WA 98506-5117 | 2006-07-08 |
| 1124056437 | Charles W Anderegg | Physician Assistant | 3901 Capital Mall Dr Sw, Ste A, Olympia, WA 98502-8654 | 2006-06-28 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1780153536 | Patricia Dorian | Physician Assistant | 2950 Squalicum Pkwy Ste B, Bellingham, WA 98225-1857 | 2018-11-21 |
| 1851875561 | Sarah Gene Soloff | Physician Assistant | 9730 3rd Ave Ne Ste 201, Seattle, WA 98115-2023 | 2018-09-18 |
| 1104308394 | Johnny Thanh Nguyen | Physician Assistant | 1135 116th Ave Ne Ste 605, Bellevue, WA 98004-4697 | 2018-09-04 |
| 1558843201 | Stefanie Eller | Physician Assistant | 532 Cedar Wood Ln, Wenatchee, WA 98801-2476 | 2018-08-29 |
| 1861987992 | Lillian Baldwin Bourret | Physician Assistant | 6317 Linden Ave N, Seattle, WA 98103-5658 | 2018-07-01 |
| 1417446758 | Janelle Elizabeth Becker | Physician Assistant | 11511 Canterwood Blvd Nw Ste 205, Gig Harbor, WA 98332 | 2018-05-02 |
| 1982058418 | Ray Johnson | Physician Assistant | 4446 88th Ave Se, Mercer Island, WA 98040 | 2016-04-21 |
| 1073990651 | Laura Skanse | Physician Assistant | 12303 Ne 130th Ln #500, Kirkland, WA 98034 | 2015-05-02 |
| 1104231893 | Amber Elaine Deck | Physician Assistant | 20307 67th Ave E, Spanaway, WA 98387-5600 | 2014-06-22 |
| 1043535024 | Pamela Baird | Physician Assistant | 2016 16th Ave East, Seattle, WA 98112-5260 | 2010-04-01 |
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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.