Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Providence Health & Services-Wa

Organization Addiction Medicine (Family Medicine) Physician · NPI 1306097415

Providence Health & Services-Wa is an Addiction Medicine (Family Medicine) Physician in Everett, Washington. Registered with an NPI since 2008.

In the registry since
2008
Specialties on file
4

Practice location Address checks out

916 Pacific Ave 1 S
Everett, WA 98201-4147
Phone: (425) 258-7390
Fax: (425) 258-7379
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Addiction Medicine (Family Medicine) Physician (primary) Taxonomy 207QA0401X
Physician Assistant Taxonomy 363A00000X
Family Nurse Practitioner Taxonomy 363LF0000X
Psychiatric/Mental Health Nurse Practitioner Taxonomy 363LP0808X

Record details

NPI number1306097415
Entity typeOrganization (Type 2)
Organization subpartNo
Authorized official Donald Anderson — Asst Secretary-Enrollment · (425) 358-9786
NPI enumeratedOctober 7, 2008
Last updated in NPPESMay 7, 2025
Certification dateMay 7, 2025
Mailing addressPo Box 31001-4110, Pasadena, CA 91110-4110

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