Basic Information
| Provider Information | |||||||||
| NPI: | 1659840445 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | FULK | ||||||||
| FirstName: | JULIA | ||||||||
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| Credential: | RDN, CD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3925 159TH AVE NE | ||||||||
| Address2: | |||||||||
| City: | REDMOND | ||||||||
| State: | WA | ||||||||
| PostalCode: | 980526309 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4252160550 | ||||||||
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| Practice Location | |||||||||
| Address1: | 4400 S HOLLY ST | ||||||||
| Address2: | |||||||||
| City: | SEATTLE | ||||||||
| State: | WA | ||||||||
| PostalCode: | 981183326 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6037176272 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/21/2018 | ||||||||
| LastUpdateDate: | 11/21/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 133V00000X | DI60899185 | WA | Y | Dietary & Nutritional Service Providers | Dietitian, Registered |
No ID Information.