Provider Demographics
NPI:1407882574
Name:FULLER, GENEVIEVE M (ARNP)
Entity Type:Individual
Prefix:MS
First Name:GENEVIEVE
Middle Name:M
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 1:7301 91ST AVE SW
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98498-3936
Mailing Address - Country:US
Mailing Address - Phone:253-267-5640
Mailing Address - Fax:253-968-5901
Practice Address - Street 1:MADIGAN ARMY MEDICAL CENTER
Practice Address - Street 2:ATTN: MCHJ-R
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98431-0001
Practice Address - Country:US
Practice Address - Phone:253-968-1111
Practice Address - Fax:253-968-5901
Is Sole Proprietor?:No
Enumeration Date:2006-06-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY338P363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health