Provider Demographics
NPI:1487052676
Name:FURULIE, COREY (ARNP, RD)
Entity type:Individual
Prefix:MR
First Name:COREY
Middle Name:
Last Name:FURULIE
Suffix:
Gender:M
Credentials:ARNP, RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1608 S J ST
Mailing Address - Street 2:1ST FLOOR, MS 35-10
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98405-4930
Mailing Address - Country:US
Mailing Address - Phone:253-274-7503
Mailing Address - Fax:253-274-7993
Practice Address - Street 1:1608 S J ST
Practice Address - Street 2:1ST FLOOR, MS 35-10
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98405-4930
Practice Address - Country:US
Practice Address - Phone:253-274-7503
Practice Address - Fax:253-274-7993
Is Sole Proprietor?:No
Enumeration Date:2014-12-20
Last Update Date:2017-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP60479749363LF0000X
WADI60286970133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily