Healthcare Provider Details

I. General information

NPI: 1194366831
Provider Name (Legal Business Name): SHARMA KAE FULLER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/03/2019
Last Update Date: 10/03/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9300 NE OAK VIEW DR
VANCOUVER WA
98662-6157
US

IV. Provider business mailing address

4701 NE 72ND AVE APT N167
VANCOUVER WA
98661-8192
US

V. Phone/Fax

Practice location:
  • Phone: 360-567-2211
  • Fax:
Mailing address:
  • Phone: 360-558-8660
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: