| Organization Name: | PROVIDENCE HEALTH & SERVICE - WASHINGTON |
| NPI Number: | 1013100262 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | NICOLE QUINN (PAYOR CREDENTIALING MANANGER) |
| Mailing Address: | 4525 3rd Ave Se Suite 200 Lacey |
| State: | WA US |
| Postal Code: | 985031010 |
| Phone Number: | 3607543934 |
| Fax Number: | 3609438023 |
| NPI Enumeration Date: | 08/21/2007 |
| NPI Last Update Date: | 12/22/2010 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 207RX0202X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | Internal Medicine |
| Taxonomy Specialization: | Medical Oncology |
| Taxonomy Definition: | An internist who specializes in the diagnosis and treatment of all types of cancer and other benign and malignant tumors. This specialist decides on and administers therapy for these malignancies as well as consults with surgeons and radiotherapists on other treatments for cancer. |