Healthcare Provider Details

I. General information

NPI: 1407882574
Provider Name (Legal Business Name): GENEVIEVE M FULLER ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/23/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

MADIGAN ARMY MEDICAL CENTER ATTN: MCHJ-R
TACOMA WA
98431-0001
US

IV. Provider business mailing address

7301 91ST AVE SW
LAKEWOOD WA
98498-3936
US

V. Phone/Fax

Practice location:
  • Phone: 253-968-1111
  • Fax: 253-968-5901
Mailing address:
  • Phone: 253-267-5640
  • Fax: 253-968-5901

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number338P
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: