Provider Demographics
NPI:1588461453
Name:FULLINGTON, IEISHA VERONICA
Entity type:Individual
Prefix:
First Name:IEISHA
Middle Name:VERONICA
Last Name:FULLINGTON
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1306 6TH ST NW APT 303
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20001-3494
Mailing Address - Country:US
Mailing Address - Phone:771-245-6255
Mailing Address - Fax:
Practice Address - Street 1:2302 HARTFORD ST SE APT 103
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20020-7963
Practice Address - Country:US
Practice Address - Phone:202-400-8829
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-27
Last Update Date:2025-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant