Organization
EVERGREEN CHILDREN'S CLINIC
Active
Other names
Pediatrics PM
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. SUSANNE I ROACH (OFFICE MANAGER)
(253) 848-2303
Entity
Organization
Contact information
Practice address
1910 MERIDIAN ST S, SUITE A, PUYALLUP, WA 98371-7531
(253) 848-2303
(253) 848-8956
Mailing address
1910 MERIDIAN ST S, SUITE A, PUYALLUP, WA 98371-7531
(253) 848-2303
(253) 848-8956
Taxonomy
Speciality
Code
Description
License number
State
363LP0200X
Pediatric Nurse Practitioner
Primary
AP60305667
WA
Other
Enumeration date
08/23/2012
Last updated
08/23/2012
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