Nurse Practitioner, Pediatrics
EVERGREEN CHILDREN'S CLINIC
Identity confirmed via CMS NPPES · September 30, 2026 · A directory match is not a coverage approval.
Is this your practice? This listing was imported from public provider identity data (CMS NPPES) and has not yet been claimed. Claim this listing to confirm the practice details. Plan acceptance stays unpublished until the practice reports it.
Public record
NPI 1750639704 · enumerated 2012-08-23 · record updated 2012-08-23. Source: CMS NPPES. A listing is not a TRICARE network approval.
NPPES recordGoogle Maps Apple Maps OpenStreetMap
Authorized official: Mrs. SUSANNE ROACH, Office Manager · (253) 848-2303
Other names: PEDIATRICS PM
Addresses and phones
- Mailing address 1910 MERIDIAN ST S, SUITE A, PUYALLUP, WA, 98371-7531 (253) 848-2303 Fax (253) 848-8956 Google Maps Apple Maps OpenStreetMap
- Practice location 1910 MERIDIAN ST S, SUITE A, PUYALLUP, WA, 98371-7531 (253) 848-2303 Fax (253) 848-8956 Google Maps Apple Maps OpenStreetMap
Specialties
- Nurse Practitioner, Pediatrics 363LP0200X · Primary · License AP60305667 WA
In this directory
Locations and evidence
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Practice location
PUYALLUP, WA, 983717531
Accepting new patientsNot reportedCMS NPPES · September 30, 2026
Plan acceptance
- No published plan acceptance yet. Confirm directly with the practice, or claim this listing if it's yours.