| Organization Name: | PROVIDENCE HEALTH & SERVICES-WA |
| NPI Number: | 1164747242 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | MARCY NICOL (RCM DIRECTOR NWR PHYSICIAN DIVISION) |
| Mailing Address: | 1717 13th Street Everett |
| State: | WA US |
| Postal Code: | 982011621 |
| Phone Number: | 4252975500 |
| Fax Number: | 4252975505 |
| NPI Enumeration Date: | 04/01/2010 |
| NPI Last Update Date: | 06/20/2012 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 208D00000X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | WA |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | General Practice |
| Taxonomy Specialization: | |
| Taxonomy Definition: | |