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

Providence Health & Services - Washington

Organization Family Medicine Physician · NPI 1063663458

Providence Health & Services - Washington is a Family Medicine Physician in Marysville, Washington. Registered with an NPI since 2008.

In the registry since
2008
Specialties on file
5

Practice location Address checks out

11603 State Ave Ste G
Marysville, WA 98271-8465
Phone: (360) 658-6800
Fax: (360) 658-6819
Show map & directions

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

Specialties & licences

Family Medicine Physician (primary) Taxonomy 207Q00000X
Internal Medicine Physician Taxonomy 207R00000X
Pediatrics Physician Taxonomy 208000000X
General Practice Physician Taxonomy 208D00000X
Durable Medical Equipment & Medical Supplies Taxonomy 332B00000X

Record details

NPI number1063663458
Entity typeOrganization (Type 2)
Organization subpartNo
Authorized official Donald Anderson — Assistant Secretary Of Enrollments · (425) 358-9786
Other names Pmg Nw Wa Marysville Clinic; Pmg Nw Wa Marysville Clinic
NPI enumeratedOctober 4, 2008
Last updated in NPPESMay 12, 2025
Certification dateMay 12, 2025
Mailing addressPo Box 31001-4114, Pasadena, CA 91110-4114

Other providers in Marysville