PROVIDENCE EVERETT MEDICAL CENTER (NPI# 1104993716) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1104993716 |
| Entity Type | Organization |
| Organization Name | PROVIDENCE EVERETT MEDICAL CENTER |
| Other Organization Name | PROVIDENCE LACTATION SERVICES |
| Practice Address |
916 Pacific Ave 7th Floor Everett WA 98201-4147 |
| Mailing Address |
909 N Broadway Pbo Credentialing Everett WA 98201-1409 |
| Practice Telephone | 4253046160 |
| Practice Fax Number | 4253046153 |
| Mailing Telephone | 4253170699 |
| Mailing Fax Number | 4253170291 |
| Enumeration Date | 2006-11-29 |
| Last Update Date | 2008-09-22 |
| Authorized Official Name | MRS. JOYCE KOBAYASHI (DIR REVENUE CYCLE MGMT NWSA) |
| Authorized Official Telephone | 4253170186 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363L00000X | Nurse Practitioner | Physician Assistants & Advanced Practice Nursing Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| WA | 9637786 | 05 | |
| WA | 7124910 | 05 |
| Other Name | Type Code |
|---|---|
| Providence Lactation Services | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1073773198 | Providence Everett Medical Center | Clinic/Center | 4112 Harbour Pointe Blvd, Suite 100, Mukilteo, WA 98275-4700 | 2008-06-12 |
| 1982805784 | Providence Everett Medical Center | Social Worker | 900 Pacific Ave, First Floor, Everett, WA 98201-4168 | 2007-05-30 |
| 1538377957 | Providence Everett Medical Center | Clinical Medical Laboratory | 1321 Colby Ave, Everett, WA 98201-1665 | 2007-05-18 |
| 1063551596 | Providence Everett Medical Center | Clinic/Center | 916 Pacific Ave, 7th Floor, Everett, WA 98201-4147 | 2007-02-05 |
| 1740344100 | Providence Everett Medical Center | Nutritionist | 916 Pacific Ave, 7th Floor, Everett, WA 98201-4147 | 2006-12-20 |
| 1255495024 | Providence Everett Medical Center | Nutritionist | 900 Pacific Ave, First Floor, Everett, WA 98201-4168 | 2006-12-19 |
| 1770643629 | Providence Everett Medical Center | Nurse Practitioner | 916 Pacific Ave, 1 South, Everett, WA 98201-4147 | 2006-12-11 |
| 1447326574 | Providence Everett Medical Center | Clinic/Center | 900 Pacific Ave, Suite 200, Everett, WA 98201-4168 | 2006-11-28 |
| 1992871735 | Providence Everett Medical Center | Clinic/Center | 1001 N Broadway, Suite A-3, Everett, WA 98201-1586 | 2006-11-24 |
| 1740365766 | Providence Everett Medical Center | Dietitian, Registered | 916 Pacific Ave, 7th Floor, Everett, WA 98201-4147 | 2006-10-26 |
| Entity Type | Entity Name | Entity Address |
|---|---|---|
| Washington State Corporations | PROVIDENCE EVERETT MEDICAL CENTER | 1321 Colby Ave, Everett, WA 98206 |
| Street Address |
916 PACIFIC AVE 7TH FLOOR |
| City | EVERETT |
| State | WA |
| Zip Code | 98201-4147 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1245203587 | Elizabeth Gearou | Physical Therapist | 916 Pacific Ave, Everett, WA 98201-4147 | 2006-02-08 |
| 1588294854 | Providence Health & Services-wa | Clinic/Center | 916 Pacific Ave, Everett, WA 98201-4147 | 2020-01-24 |
| 1083264873 | Olivia Bromley | Speech-Language Pathologist | 916 Pacific Ave, Everett, WA 98201-4147 | 2019-09-13 |
| 1235783952 | Katie Anacker | Physical Therapy Assistant | 916 Pacific Ave, Everett, WA 98201-4147 | 2019-07-31 |
| 1891348488 | Judith Kelly | Physical Therapist | 916 Pacific Ave, Everett, WA 98201-4147 | 2019-07-23 |
| 1669025185 | William Michael Crenshaw | Occupational Therapy Assistant | 916 Pacific Ave, Everett, WA 98201-4147 | 2019-07-23 |
| 1053963751 | Bethany Smith Gopalakrishnan | Physical Therapist | 916 Pacific Ave, Everett, WA 98201-4147 | 2019-07-12 |
| 1245891241 | Rebecca Christine Aronsen | Dietitian, Registered | 916 Pacific Ave, Everett, WA 98201-4147 | 2019-06-21 |
| 1679084719 | Emily Charoenset | Occupational Therapy Assistant | 916 Pacific Ave, Everett, WA 98201-4147 | 2017-10-16 |
| 1720505613 | Anica Rae Faucett | Occupational Therapy Assistant | 916 Pacific Ave, Everett, WA 98201-4147 | 2017-08-23 |
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| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1306471867 | Shannon Michelle Dewald | Registered Nurse | D8s 1700 13th St, Everett, WA 98201 | 2020-03-05 |
| 1578123113 | Precious Medicial Spa, LLC | Registered Nurse | 1728 W. Marine View Dr Suite 212, Everett, WA 98201 | 2019-06-17 |
| 1508429796 | Alix Deschain | Counselor | 2801 Broadway, Everett, WA 98201 | 2019-04-15 |
| 1811457534 | Khushboo Patel | Pharmacist | 1330 Rockefeller Ave Ste 150, Everett, WA 98201 | 2019-03-20 |
| 1164991188 | Grace Talbot Davis | Registered Nurse | 2601 Summit Avenue, Bldg. C, Everett, WA 98201 | 2018-11-20 |
| 1063924603 | Tracy Sisk | Counselor | 3120 Colby Ave, 502, Everett, WA 98201 | 2017-11-03 |
| 1710403126 | Michelle Durham | Counselor | 3322 Boadway Fl 2, Everett, WA 98201 | 2017-08-17 |
| 1861927949 | Melanie Schmidt | Counselor | 2610 Westmore Ave, Everett, WA 98201 | 2017-04-26 |
| 1518413327 | Joseph Madson Dmd Pllc | Clinic/Center | 3802 Colby Ave, 4th Floor, Everett, WA 98201 | 2016-08-31 |
| 1043683162 | Jennifer Adams | Counselor | 1511 26th St, Everett, WA 98201 | 2015-11-11 |
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| Taxonomy Code | 363L00000X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Nurse Practitioner |
| (1) A registered nurse provider with a graduate degree in nursing prepared for advanced practice involving independent and interdependent decision making and direct accountability for clinical judgment across the health care continuum or in a certified specialty. (2) A registered nurse who has completed additional training beyond basic nursing education and who provides primary health care services in accordance with state nurse practice laws or statutes. Tasks performed by nurse practitioners vary with practice requirements mandated by geographic, political, economic, and social factors. Nurse practitioner specialists include, but are not limited to, family nurse practitioners, gerontological nurse practitioners, pediatric nurse practitioners, obstetric-gynecologic nurse practitioners, and school nurse practitioners. |
| Notes: Source: (1) American Nurses’ Association, American Nurses Credentialing Center, 1996 Certification Catalogue. (2) ) Lexikon: Dictionary of Health Care Terms, Organizations and Acronyms for the Era of Reform, The Joint Commission on Accreditation of Healthcare Organizations, Oakbrook Terrace, Illinois: 1994, p. 549. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1851933642 | Julia Kase | Nurse Practitioner | 728 134th St Sw Ste 207, Everett, WA 98204-5322 | 2019-10-13 |
| 1740765650 | Joan W Kamata | Nurse Practitioner | 38 Carter St Apt 313, Everett, MA 02149-2525 | 2018-09-26 |
| 1679092704 | Bethell Assefa | Nurse Practitioner | 3624 Colby Ave Ste B, Everett, WA 98201-4789 | 2017-09-09 |
| 1518011089 | Susan Farist Butler | Nurse Practitioner | Tri City Mhc, 173 Chelsea St, Everett, MA 02149 | 2007-01-22 |
| 1780643973 | Jessica Susan Webb | Nurse Practitioner | 12728 19th Ave Se, Suite 300, Everett, WA 98208-6526 | 2006-03-17 |
| 1063499168 | Tracy J Wilbraham | Nurse Practitioner | 173 Chelsea St, Everett, MA 02149-4632 | 2005-12-29 |
| 1912518093 | Holly Anne Bernstein | Nurse Practitioner | 3927 Rucker Ave, Everett, WA 98201-4833 | 2020-08-12 |
| 1073124491 | Alana Brianne Beck | Nurse Practitioner | 1818 121st St Se, Everett, WA 98208-5985 | 2020-08-10 |
| 1588273114 | Dayna Wong | Nurse Practitioner | 1818 121st St Se, Everett, WA 98208-5985 | 2020-07-29 |
| 1063021137 | Katelyn Pedersen | Nurse Practitioner | 3927 Rucker Ave, Everett, WA 98201-4833 | 2020-07-24 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.