Healthcare Provider Details

I. General information

NPI: 1972771186
Provider Name (Legal Business Name): STEVEN G ROBERTS FNP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/11/2008
Last Update Date: 12/01/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

325 E PIONEER AVE
PUYALLUP WA
98372-3265
US

IV. Provider business mailing address

325 E PIONEER AVE
PUYALLUP WA
98372-3265
US

V. Phone/Fax

Practice location:
  • Phone: 253-697-8550
  • Fax:
Mailing address:
  • Phone: 253-697-8550
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP30007045
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN00079183
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: