Active NPI
Su-Yong Fullmer
- Family Nurse Practitioner
- Auburn, WA
National Provider Identifier
1679290522
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Nurse Practitioner
- License
- AP61178626
- Practice address
- 200 Auburn Ave
Auburn, WA 98002-5015 - Phone
- (800) 440-3305
- Fax
- (866) 369-4424
- NPI assigned
- Oct 21, 2022
- Last updated
- Feb 19, 2023
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Nurse Practitioner | 363LF0000X | AP61178626 | WA | Primary |
Addresses
Primary practice location
200 Auburn Ave
Auburn, WA 98002-5015
Mailing address
922 66TH Ave E
Fife, WA 98424-1445
Phone (253) 831-4910
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| AP61178626 | WA | MD | Family Nurse Practitioner |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1666310400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1676764800000",
"number": "1679290522",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "922 66TH AVE E",
"city": "FIFE",
"state": "WA",
"postal_code": "984241445",
"telephone_number": "253-831-4910"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "200 AUBURN AVE",
"city": "AUBURN",
"state": "WA",
"postal_code": "980025015",
"telephone_number": "800-440-3305",
"fax_number": "866-369-4424"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FULLMER",
"first_name": "SU-YONG",
"name_prefix": "Mrs.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2022-10-21",
"last_updated": "2023-02-19",
"certification_date": "2023-02-19",
"status": "A"
},
"taxonomies": [
{
"code": "363LF0000X",
"taxonomy_group": "",
"desc": "Nurse Practitioner, Family",
"state": "WA",
"license": "AP61178626",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Auburn, WA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 19, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.