Provider Demographics
NPI:1669557468
Name:FELLNER, BILLIE JANE
Entity type:Individual
Prefix:
First Name:BILLIE
Middle Name:JANE
Last Name:FELLNER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:B
Other - Middle Name:JANE
Other - Last Name:FELLNER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 50095
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98145-5095
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:UW CAMPUS
Practice Address - Street 2:EAST STEVENS CIRCLE
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98195-4410
Practice Address - Country:US
Practice Address - Phone:206-616-2495
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-27
Last Update Date:2009-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00017478207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8299604Medicaid
4235OtherINTERNAL ID-MOTOR VEHICLE ID
B18205Medicare UPIN
4235OtherINTERNAL ID-MOTOR VEHICLE ID