Healthcare Provider Details

I. General information

NPI: 1154111789
Provider Name (Legal Business Name): ANNALISE VUE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/07/2025
Last Update Date: 05/07/2025
Certification Date: 04/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1701 13TH ST SE
PUYALLUP WA
98372-4707
US

IV. Provider business mailing address

14217 103RD AVENUE CT E APT D105
PUYALLUP WA
98374-3843
US

V. Phone/Fax

Practice location:
  • Phone: 253-848-0880
  • Fax:
Mailing address:
  • Phone: 253-385-7585
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: