EVERGREEN CHILDREN'S CLINIC PLLC NPI 1568527539

NPI Information

  • NPI: 1568527539
  • Provider Name: EVERGREEN CHILDREN'S CLINIC, PLLC
  • Classification: Pediatrics - 2080A0000X
  • Specialization: Adolescent Medicine
  • Entity Type: Organization
  • Other Name: PEDIATRICS PM
  • Address: 1910 S MERIDIAN
    SUITE A
    PUYALLUP, WA
    ZIP 98371
  • Phone: (253) 848-2303

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NPI Details

EVERGREEN CHILDREN'S CLINIC, PLLC is an adolescent medicine pediatrics in Puyallup, WA. The provider is a pediatrician who specializes in adolescent medicine is a multi-disciplinary healthcare specialist trained in the unique physical, psychological and social characteristics of adolescents, their healthcare problems and needs. EVERGREEN CHILDREN'S CLINIC, PLLC NPI is 1568527539. The provider is registered as an organization entity type and is a single specialty group.
The provider Other Name Is Pediatrics Pm.

The provider's business location address is:

1910 S MERIDIAN
SUITE A
PUYALLUP, WA
ZIP 98371-531
Phone: (253) 848-2303
Fax: (253) 848-8956

The provider's authorized official is Susanne I Roach .
The authorized official title is Office Manager and has the following contact phone number (253) 848-2303.

The enumeration date for this NPI number is 12/27/2006 and was last updated on 8/22/2020.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
12080A0000XPediatricsAdolescent MedicineYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No. Other Provider Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer
17054364MEDICAIDWASHINGTON

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/21/2025

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