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Organization
EVERGREEN PEDIATRIC CLINIC PS
Active
Organization
EVERGREEN PEDIATRIC CLINIC PS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TERI BRYANT (OFFICE MANAGER)
(360) 892-1635
Entity
Organization
Contact information
Practice address
505 NE 87TH AVE, STE 120, VANCOUVER, WA 98664-1989
(360) 892-1635
(360) 892-3146
Mailing address
505 NE 87TH AVE, STE 120, VANCOUVER, WA 98664-1989
(360) 892-1635
(360) 892-3146
Taxonomy
Speciality
Code
Description
License number
State
2080A0000X
Pediatric Adolescent Medicine Physician
Primary
601 115 723
WA
Other
Enumeration date
04/09/2007
Last updated
02/21/2020
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