Active NPI
Evergreen Mobile NP
- Nurse Practitioner
- Puyallup, WA
National Provider Identifier
1689582488
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Nurse Practitioner
- Legal business name
- EVERGREEN MOBILE NP
- Practice address
- 2411 43Rd Ave SE
Puyallup, WA 98374-4180 - Phone
- (734) 239-1192
- NPI assigned
- Sep 1, 2026
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Man M Le, NP-C
- Title
- Owner/ Nurse Practitioner
- Phone
- (734) 239-1192
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Nurse Practitioner | 363L00000X | Primary |
Addresses
Primary practice location
2411 43Rd Ave SE
Puyallup, WA 98374-4180
Mailing address
2411 43Rd Ave SE
Puyallup, WA 98374-4180
Phone (734) 239-1192
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1788220800000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1788220800000",
"number": "1689582488",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2411 43RD AVE SE",
"city": "PUYALLUP",
"state": "WA",
"postal_code": "983744180",
"telephone_number": "734-239-1192"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2411 43RD AVE SE",
"city": "PUYALLUP",
"state": "WA",
"postal_code": "983744180",
"telephone_number": "734-239-1192"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "EVERGREEN MOBILE NP",
"organizational_subpart": "NO",
"enumeration_date": "2026-09-01",
"last_updated": "2026-09-01",
"certification_date": "2026-09-01",
"status": "A",
"authorized_official_last_name": "LE",
"authorized_official_first_name": "MAN",
"authorized_official_middle_name": "M",
"authorized_official_title_or_position": "OWNER/ NURSE PRACTITIONER",
"authorized_official_telephone_number": "734-239-1192",
"authorized_official_credential": "NP-C"
},
"taxonomies": [
{
"code": "363L00000X",
"taxonomy_group": "193400000X SINGLE SPECIALTY GROUP",
"desc": "Nurse Practitioner",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Puyallup, WA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 1, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.