Healthcare Provider Details

I. General information

NPI: 1598316473
Provider Name (Legal Business Name): YOSEF FUFA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/23/2019
Last Update Date: 12/22/2024
Certification Date: 12/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

UNIT 45011
APO AP
96343-5011
US

IV. Provider business mailing address

UNIT 45011
APO AP
96343-5011
US

V. Phone/Fax

Practice location:
  • Phone: 315-263-4127
  • Fax:
Mailing address:
  • Phone: 315-263-4127
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License NumberRN00172813
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAP61178851
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: