Provider Demographics
NPI:1366519985
Name:FULMER, KATHLEEN JUNE (ARNP)
Entity type:Individual
Prefix:MS
First Name:KATHLEEN
Middle Name:JUNE
Last Name:FULMER
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 BARNEBURG
Mailing Address - Street 2:
Mailing Address - City:DOVE CANYON
Mailing Address - State:CA
Mailing Address - Zip Code:92679-4210
Mailing Address - Country:US
Mailing Address - Phone:949-589-2808
Mailing Address - Fax:
Practice Address - Street 1:10941 BLOOMFIELD ST
Practice Address - Street 2:SUITE #A
Practice Address - City:LOS ALAMITOS
Practice Address - State:CA
Practice Address - Zip Code:90720-2530
Practice Address - Country:US
Practice Address - Phone:568-596-1667
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA13693363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily