IndividualActive
Dereka Wallace, RN
NPI 1346040649 · Emergency Registered Nurse · Puyallup, WA
Provider details
- NPI number
- 1346040649
- Entity type
- Individual
- Primary specialty
- Emergency Registered NurseNursing Service Providers
- Credential
- RN
- Sex
- Female
- Sole proprietor
- No
- License
- 61519413 (WA)
Specialties & taxonomies
Nursing Service Providers
Practice location
401 15th Ave Se
Puyallup, WA 98372-3715
Phone: (253) 697-4000
Approximate (ZIP-level) locationGet directions
Mailing address
401 15th Ave Se
Puyallup, WA 98372-3715
Registry dates
- Enumerated
- 2025-03-17
- Last updated
- 2025-03-17
- Certified
- 2025-03-16
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.