Individual
GREG L. FULLMER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
AGNP-C
Contact information
Practice address
4815 N ASSEMBLY ST, SPOKANE, WA 99205-6185
(509) 434-7000
Mailing address
803 E ELM AVE, COEUR D ALENE, ID 83814-4438
(619) 456-1337
Taxonomy
Speciality
Code
Description
License number
State
363LG0600X
Gerontology Nurse Practitioner
Primary
5271681
ID
Other
Enumeration date
10/06/2025
Last updated
10/06/2025
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