Healthcare Provider Details

I. General information

NPI: 1689565442
Provider Name (Legal Business Name): ANGELA ROSE ROULLIER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/10/2025
Last Update Date: 07/10/2025
Certification Date: 07/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3713 PACIFIC AVE STE E
TACOMA WA
98418-7845
US

IV. Provider business mailing address

3713 PACIFIC AVE STE E
TACOMA WA
98418-7845
US

V. Phone/Fax

Practice location:
  • Phone: 253-433-7993
  • Fax: 253-540-6886
Mailing address:
  • Phone: 253-433-7993
  • Fax: 253-540-6886

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: