| NPI | 1316125149 |
|---|---|
| Doing Business As | PROVIDENCE MEDICAL GROUP |
| Doing Business As | PROVIDENCE PEDIATRIC NEUROLOGY MJP |
| Entity Type | Organization |
| Authorized Contact | DONALD WAYNE ANDERSON Assistant Secretary Enrollment 425-358-9786 |
| Organization Subpart ? | No |
| Primary Taxonomy | 2084N0402X Psychiatry & Neurology, Neurology with Special Qualifications in Child Neurology |
| Additional Taxonomies | 261Q00000X Clinic/Center |
| Enumeration Date | 2008-02-04 |
| Last Update Date | 2025-07-04 |