MEDICARE: MRS. ABIGAIL ABERILLA TULLIUS NP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363L00000X	Nurse Practitioner	AP61327423	WA

General Provider Information

NPI Number	:	1306579669
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. ABIGAIL ABERILLA TULLIUS NP

Provider Business Mailing Address
First Line	:	201 SUZANNE LN
Second Line	:
City	:	MOUNT VERNON
State	:	WA
Zip	:	98273-9514
Country	:	US
Telephone Number	:	360-720-6682
Fax Number	:

Provider Business Practice Location Address
First Line	:	201 SUZANNE LN
Second Line	:
City	:	MOUNT VERNON
State	:	WA
Zip	:	98273-9514
Country	:	US
Telephone Number	:	360-416-1960
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/05/2022
Last Update Date	:	07/29/2022

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