Provider Demographics
NPI:1508650623
Name:FULLERTON, VIKTORYA MIKAY
Entity type:Individual
Prefix:
First Name:VIKTORYA
Middle Name:MIKAY
Last Name:FULLERTON
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:KASSANDRA
Other - Middle Name:MIKAYLA
Other - Last Name:BONTJES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2703 W CHESTNUT AVE
Mailing Address - Street 2:
Mailing Address - City:YAKIMA
Mailing Address - State:WA
Mailing Address - Zip Code:98902-3723
Mailing Address - Country:US
Mailing Address - Phone:509-902-2721
Mailing Address - Fax:
Practice Address - Street 1:2703 W CHESTNUT AVE
Practice Address - Street 2:
Practice Address - City:YAKIMA
Practice Address - State:WA
Practice Address - Zip Code:98902-3723
Practice Address - Country:US
Practice Address - Phone:509-902-2721
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-04
Last Update Date:2025-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA374J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula