Pediatric Health Care

Primary specialty

Pediatric Nurse PractitionerTaxonomy code 363LP0200X

License

60705836 Issued in WA

Legal business name

PEDIATRIC HEALTH CARE

Practice address

1420 3Rd St SE
Ste. 200
Puyallup, WA 98372-3730

Phone

(253) 848-7660

Fax

(253) 841-1801

NPI assigned

Nov 8, 2016

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mazen Dahan, M.D.NPI 1578671830

Title

F.a.a.P.

Phone

(253) 848-7660

Specialties & licenses 1

Addresses

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Tax ID family

Pediatric Health Care2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• Pediatric Health Care

  • Health Maintenance Organization
  • Puyallup, WA
  • NPI 1992965750
  NPD tax ID

Locations

Interoperability endpoints

• FHIR API: https://fhir-myrecord.cerner.com/r4/406d860b-12fc-4de0-877e-16ab01dbbff5/

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Mazen Dahan, MD

  • Pediatrics Physician
  • Puyallup, WA
  • NPI 1578671830
  NPD (past) Authorized official
• Yolanda Lacher Bradford Rodriguez, ARNP, FNP-BC

  • Family Nurse Practitioner
  • Puyallup, WA
  • NPI 1639609159
  NPD (past)
• Tera L. Johnson, CPNP-PC

  • Pediatric Nurse Practitioner
  • Baton Rouge, LA
  • NPI 1649712548

  Pediatrics

  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1478563200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1478563200000",
    "number": "1689116691",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1420 3RD ST SE",
            "address_2": "STE. 200",
            "city": "PUYALLUP",
            "state": "WA",
            "postal_code": "983723730",
            "telephone_number": "253-848-7660",
            "fax_number": "253-841-1801"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1420 3RD ST SE",
            "address_2": "STE. 200",
            "city": "PUYALLUP",
            "state": "WA",
            "postal_code": "983723730",
            "telephone_number": "253-848-7660",
            "fax_number": "253-841-1801"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PEDIATRIC HEALTH CARE",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-11-08",
        "last_updated": "2016-11-08",
        "status": "A",
        "authorized_official_last_name": "DAHAN",
        "authorized_official_first_name": "MAZEN",
        "authorized_official_title_or_position": "F.A.A.P.",
        "authorized_official_telephone_number": "253-848-7660",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "363LP0200X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Nurse Practitioner, Pediatrics",
            "state": "WA",
            "license": "60705836",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kelly S Peck, MA
• Annamarie Pedersen, MA, LMFT
• Isaak Pedersen
• Maegan Pedersen
• Alison E Pederson
• Pediatric Health Care
• Pediatric Infusion Services LLC
• Kirsten Peebles, LMHC
• Shannon Marie Peerboom, ARNP
• Pegasus Lifts, LLC

• Pediatric Nurse Practitioner in Puyallup, WA
• Providers in Puyallup, WA by specialty
• Pediatric Nurse Practitioner in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 8, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.