Healthcare Provider Details

I. General information

NPI: 1376096156
Provider Name (Legal Business Name): BILLIE JO FULNER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: BILLIE JO LOSIEVSKI

II. Dates (important events)

Enumeration Date: 07/28/2016
Last Update Date: 07/28/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9040 JACKSON AVENUE, ATTN: MCHJ-CLQ-C MADIGAN ARMY MEDICAL CENTER
TACOMA WA
98431-1100
US

IV. Provider business mailing address

9040 JACKSON AVENUE, ATTN: MCHJ-CLQ-C MADIGAN ARMY MEDICAL CENTER
TACOMA WA
98431-1100
US

V. Phone/Fax

Practice location:
  • Phone: 253-968-3020
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WM0705X
TaxonomyMedical-Surgical Registered Nurse
License Number211773
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: