| NPI | 1811211220 |
|---|---|
| Doing Business As | PROVIDENCE MEDICAL GROUP |
| Entity Type | Organization |
| Authorized Contact | DONALD WAYNE ANDERSON Assistant Secretary Enrollments 425-525-5392 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261Q00000X Clinic/Center |
| Additional Taxonomies | 207RH0003X Internal Medicine Hematology & Oncology |
| 363L00000X Nurse Practitioner | |
| Enumeration Date | 2010-03-15 |
| Last Update Date | 2024-09-03 |