Individual
DEREKA WALLACE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RN
Contact information
Practice address
401 15TH AVE SE, PUYALLUP, WA 98372-3715
(253) 697-4000
Mailing address
401 15TH AVE SE, PUYALLUP, WA 98372-3715
(253) 697-4000
Taxonomy
Speciality
Code
Description
License number
State
163WE0003X
Emergency Registered Nurse
Primary
61519413
WA
Other
Enumeration date
03/17/2025
Last updated
03/17/2025
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