Evergreen Children'S Clinic

Primary specialty

Pediatric Nurse PractitionerTaxonomy code 363LP0200X

License

AP60305667 Issued in WA

Legal business name

EVERGREEN CHILDREN'S CLINIC

Practice address

1910 Meridian St S
Suite a
Puyallup, WA 98371-7531

Phone

(253) 848-2303

Fax

(253) 848-8956

NPI assigned

Aug 23, 2012

Organization subpart

No

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

Authorized official

Name

Mrs. Susanne I Roach

Title

Office Manager

Phone

(253) 848-2303

Specialties & licenses 1

Addresses

Other names 1

• Pediatrics PM Other name

Tax ID family

Evergreen Children'S Clinic2 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.

• Evergreen Children'S Clinic, PLLC

  • Pediatric Adolescent Medicine Physician
  • Puyallup, WA
  • NPI 1568527539
  NPD tax ID

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

{
    "created_epoch": "1345680000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1345680000000",
    "number": "1750639704",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1910 MERIDIAN ST S",
            "address_2": "SUITE A",
            "city": "PUYALLUP",
            "state": "WA",
            "postal_code": "983717531",
            "telephone_number": "253-848-2303",
            "fax_number": "253-848-8956"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1910 MERIDIAN ST S",
            "address_2": "SUITE A",
            "city": "PUYALLUP",
            "state": "WA",
            "postal_code": "983717531",
            "telephone_number": "253-848-2303",
            "fax_number": "253-848-8956"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EVERGREEN CHILDREN'S CLINIC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-08-23",
        "last_updated": "2012-08-23",
        "status": "A",
        "authorized_official_last_name": "ROACH",
        "authorized_official_first_name": "SUSANNE",
        "authorized_official_middle_name": "I",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "253-848-2303",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "363LP0200X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Nurse Practitioner, Pediatrics",
            "state": "WA",
            "license": "AP60305667",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Pediatrics PM",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Hermenigilda Ang Eusebio, FNP
• Brittany Evans, LMP
• Rachel Ruh Evans, RD
• Julie Evens
• Evercare Massage Therapy
• Evergreen Children'S Clinic, PLLC
• Evergreen Mobile NP
• Michael Everly, LMT
• Aaron Wade Eversaul Jr., PHARMD
• Everside Health, 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 Aug 23, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.