Provider Demographics
NPI:1295990984
Name:FULLER, LYNNA DUNN (LMP, PHD)
Entity type:Individual
Prefix:DR
First Name:LYNNA
Middle Name:DUNN
Last Name:FULLER
Suffix:
Gender:F
Credentials:LMP, PHD
Other - Prefix:DR
Other - First Name:LYNNA
Other - Middle Name:LOUISE
Other - Last Name:DUNN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMT
Mailing Address - Street 1:2304 H ST
Mailing Address - Street 2:
Mailing Address - City:BELLINGHAM
Mailing Address - State:WA
Mailing Address - Zip Code:98225-3318
Mailing Address - Country:US
Mailing Address - Phone:425-328-8823
Mailing Address - Fax:
Practice Address - Street 1:1756 IOWA ST
Practice Address - Street 2:
Practice Address - City:BELLINGHAM
Practice Address - State:WA
Practice Address - Zip Code:98229-4702
Practice Address - Country:US
Practice Address - Phone:360-734-9555
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-07-23
Last Update Date:2016-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60023935225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist