Provider Demographics
NPI:1053826883
Name:FULLER, KRISTEN
Entity Type:Individual
Prefix:MRS
First Name:KRISTEN
Middle Name:
Last Name:FULLER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5978 HIGHWAY 291 STE 2
Mailing Address - Street 2:
Mailing Address - City:NINE MILE FALLS
Mailing Address - State:WA
Mailing Address - Zip Code:99026-5105
Mailing Address - Country:US
Mailing Address - Phone:509-934-1981
Mailing Address - Fax:509-381-5925
Practice Address - Street 1:5978 HIGHWAY 291 STE 2
Practice Address - Street 2:
Practice Address - City:NINE MILE FALLS
Practice Address - State:WA
Practice Address - Zip Code:99026-5105
Practice Address - Country:US
Practice Address - Phone:509-934-1981
Practice Address - Fax:509-381-5925
Is Sole Proprietor?:No
Enumeration Date:2017-12-01
Last Update Date:2017-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374700000XNursing Service Related ProvidersTechnician