Healthcare Provider Details

I. General information

NPI: 1841445392
Provider Name (Legal Business Name): ROCHELLE RENEE GREGOIRE A.A.S., HIS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/25/2008
Last Update Date: 08/18/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1901 S UNION AVE STE. B-2001
TACOMA WA
98405-1702
US

IV. Provider business mailing address

PO BOX 350
MAPLE VALLEY WA
98038-0350
US

V. Phone/Fax

Practice location:
  • Phone: 253-272-3090
  • Fax: 253-627-1415
Mailing address:
  • Phone: 425-358-0956
  • Fax: 877-481-6931

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License NumberHA 60010599
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: