Basic Information
| Provider Information | |||||||||
| NPI: | 1982038063 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | PROULX | ||||||||
| FirstName: | GREGORY | ||||||||
| MiddleName: | BRYANT | ||||||||
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| Credential: | ARNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 15214 CANYON RD E | ||||||||
| Address2: | STE 120 | ||||||||
| City: | PUYALLUP | ||||||||
| State: | WA | ||||||||
| PostalCode: | 983757472 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2535394200 | ||||||||
| FaxNumber: | 2535396025 | ||||||||
| Practice Location | |||||||||
| Address1: | 15214 CANYON RD E | ||||||||
| Address2: | STE 120 | ||||||||
| City: | PUYALLUP | ||||||||
| State: | WA | ||||||||
| PostalCode: | 983757472 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2535394200 | ||||||||
| FaxNumber: | 2535396025 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/26/2013 | ||||||||
| LastUpdateDate: | 11/21/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | AP60390201 | WA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.