Provider Demographics
NPI:1093095663
Name:FULLER, DEBRA JOHNSON (ARNP)
Entity Type:Individual
Prefix:
First Name:DEBRA
Middle Name:JOHNSON
Last Name:FULLER
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:105 W 8TH AVE
Mailing Address - Street 2:SUITE 7050
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99204-2341
Mailing Address - Country:US
Mailing Address - Phone:509-252-1711
Mailing Address - Fax:509-747-0416
Practice Address - Street 1:105 W 8TH AVE
Practice Address - Street 2:SUITE 7050
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99204-2341
Practice Address - Country:US
Practice Address - Phone:509-252-1711
Practice Address - Fax:509-747-0416
Is Sole Proprietor?:No
Enumeration Date:2011-08-26
Last Update Date:2016-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP60228998363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily