EVERGREEN CHILDREN'S CLINIC (NPI# 1750639704) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
Nation Provider ID (NPI) | 1750639704 |
Entity Type | Organization |
Organization Name | EVERGREEN CHILDREN'S CLINIC |
Other Organization Name | PEDIATRICS PM |
Practice Address |
1910 Meridian St S Suite A Puyallup WA 98371-7531 |
Practice Telephone | 2538482303 |
Practice Fax Number | 2538488956 |
Mailing Telephone | 2538482303 |
Mailing Fax Number | 2538488956 |
Enumeration Date | 2012-08-23 |
Last Update Date | 2012-08-23 |
Authorized Official Name | MRS. SUSANNE I ROACH (OFFICE MANAGER) |
Authorized Official Telephone | 2538482303 |
Is Organization Subpart | N |
Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
---|---|---|---|---|---|
Y | 363LP0200X |
Nurse Practitioner Specialization: Pediatrics |
AP60305667 | WA | Physician Assistants & Advanced Practice Nursing Providers |
Other Name | Type Code |
---|---|
Pediatrics PM | Other Name - Individual/Organization |
Street Address |
1910 MERIDIAN ST S SUITE A |
City | PUYALLUP |
State | WA |
Zip Code | 98371-7531 |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1366428369 | Roselynn Wee Sim Cuenca | Pediatrics | 1910 Meridian St S, Ste A, Puyallup, WA 98371-7531 | 2005-12-21 |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1588141550 | Karen Lynn Sorensen | Massage Therapist | 922 Valley Ave Nw Suite 101, Puyallup, WA 98371 | 2018-07-23 |
1487140257 | Bradley Dupea | Specialist/Technologist | 5702 44th St Se, Puyallup, WA 98371 | 2018-07-05 |
1740778695 | Pedraum Heydari | Dentist | 109 N Meridian Suite A, Puyallup, WA 98371 | 2018-04-26 |
1487030359 | Jennifer Block | Dental Hygienist | 601 4th Ave Sw, Puyallup, WA 98371 | 2015-08-03 |
1023423431 | On Your Own Inc. | Registered Nurse | 1602 Peach Park Ln Nw, Puyallup, WA 98371 | 2014-06-24 |
1841614997 | Enrique Somera | Registered Nurse | 1107 29th St Nw, Puyallup, WA 98371 | 2014-02-10 |
1033540893 | Ching Ju Chuang | Dentist | 1002 N. Meridian, Suite 104a, Puyallup, WA 98371 | 2013-12-04 |
1104161876 | Denise L. Vanaman | Registered Nurse | 214 W. Main, Puyallup, WA 98371 | 2012-12-06 |
1336491018 | Tacoma School District | Physical Therapy Assistant | 1721 8th Ave. S.w., Puyallup, WA 98371 | 2012-10-05 |
1275882052 | Robert Francis Saxton | Health Educator | 1121 W. Stewart, Puyallup, WA 98371 | 2012-09-07 |
Find all providers in zip 98371 |
Taxonomy Code | 363LP0200X |
Grouping | Physician Assistants & Advanced Practice Nursing Providers |
Classification | Nurse Practitioner |
Specialization | Pediatrics |
Definition to come... |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1336260280 | Roberta Louise Salveson | Nurse Practitioner | 319 5th St Nw, Puyallup, WA 98371 | 2007-04-02 |
1124105408 | Shawna Hood | Nurse Practitioner | 1706 S Meridian, Suite 120, Puyallup, WA 98371-7516 | 2006-11-01 |
1922026178 | Theresa J Harris | Nurse Practitioner | 1706 S Meridian Ste 130, Puyallup, WA 98371-7516 | 2006-07-17 |
1467965954 | Heather Buzbee | Nurse Practitioner | 10217 125th Street Ct E, Puyallup, WA 98374-2761 | 2017-11-07 |
1073041364 | Lisa Ann Oberlander | Nurse Practitioner | 11102 Sunrise Blvd E Ste 103, Puyallup, WA 98374-8846 | 2017-05-31 |
1689116691 | Pediatric Health Care | Nurse Practitioner | 1420 3rd St Se, Ste. 200, Puyallup, WA 98372-3730 | 2016-11-08 |
1649712548 | Tera L. Johnson | Nurse Practitioner | 1420 3rd St Se, Ste. 200, Puyallup, WA 98372-3730 | 2016-11-08 |
1558716043 | Emily Winn | Nurse Practitioner | 11102 Sunrise Blvd E, Suite 103, Puyallup, WA 98374-8846 | 2016-05-03 |
1801293949 | Devyn Catherine Cameron | Nurse Practitioner | 11102 Sunrise Blvd E, Suite 103, Puyallup, WA 98374-8846 | 2014-12-03 |
1114280476 | Julia Berndt Rapp | Nurse Practitioner | 10217 125th Street Ct E Fl 2, Puyallup, WA 98374-2761 | 2012-06-21 |
Find all providers in PUYALLUP |
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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.