Provider Demographics
NPI:1750924536
Name:TULLIS, AUSTEN DIANE (DNP)
Entity type:Individual
Prefix:
First Name:AUSTEN
Middle Name:DIANE
Last Name:TULLIS
Suffix:
Gender:F
Credentials:DNP
Other - Prefix:
Other - First Name:AUSTEN
Other - Middle Name:DIANE
Other - Last Name:MOFFITT
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DNP
Mailing Address - Street 1:13611 N RIVERBLUFF LN
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99208-9250
Mailing Address - Country:US
Mailing Address - Phone:509-481-3741
Mailing Address - Fax:
Practice Address - Street 1:235 E ROWAN AVE STE 202
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99207-1240
Practice Address - Country:US
Practice Address - Phone:509-474-5858
Practice Address - Fax:832-463-6621
Is Sole Proprietor?:No
Enumeration Date:2019-10-23
Last Update Date:2021-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP143607363LF0000X
WAAP61140649363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily