Provider Demographics
NPI:1336260280
Name:SALVESON, ROBERTA LOUISE (CPNP)
Entity Type:Individual
Prefix:MS
First Name:ROBERTA
Middle Name:LOUISE
Last Name:SALVESON
Suffix:
Gender:F
Credentials:CPNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:319 5TH ST SW
Mailing Address - Street 2:
Mailing Address - City:PUYALLUP
Mailing Address - State:WA
Mailing Address - Zip Code:98371-5828
Mailing Address - Country:US
Mailing Address - Phone:253-848-0351
Mailing Address - Fax:253-841-1397
Practice Address - Street 1:319 5TH ST NW
Practice Address - Street 2:
Practice Address - City:PUYALLUP
Practice Address - State:WA
Practice Address - Zip Code:98371
Practice Address - Country:US
Practice Address - Phone:253-841-1397
Practice Address - Fax:253-841-1397
Is Sole Proprietor?:No
Enumeration Date:2007-04-02
Last Update Date:2017-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP60234630363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics