EVERGREEN CHILDREN'S CLINIC NPI 1750639704

NPI Information

EVERGREEN CHILDREN'S CLINIC is a pediatrics nurse practitioner in Puyallup, WA. EVERGREEN CHILDREN'S CLINIC NPI is 1750639704. 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 MERIDIAN ST S
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 8/23/2012 and was last updated on 8/23/2012.

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:

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