Individual
MS. CAROLYN STARR FULLMER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PAC
Contact information
Practice address
410 E KING ST, CHEWELAH, WA 99109-0137
(509) 935-8711
(509) 935-4882
Mailing address
PO BOX 137, CHEWELAH, WA 99109-0137
(509) 935-8711
(509) 935-4882
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA10003285
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0159376
WA STATE L&I
WA
05
—
8511230
—
WA
01
—
PA10003285
WA STATE LICENSE
WA
Enumeration date
01/19/2007
Last updated
06/18/2008
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