Doctor Name: | SHERRI FULLER |
NPI Number: | 1053346791 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | NP |
License Number: | R1104617 |
Business Practice Address: | 303 E Nicollet Blvd Suite 200 Burnsville, MN - 553374522 |
Business Phone Number: | 9524604000 |
Business Fax Number: | 9524604000 |
Mailing Address: | 303 E Nicollet Blvd, Suite 200 BURNSVILLE |
State: | MN |
Postal Code: | 553374522 |
Phone Number: | 9524604000 |
Fax Number: | 9524604000 |
NPI Enumeration Date: | 07/11/2006 |
NPI Last Update Date: | 04/11/2012 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363LA2200X |
License Number: | R1104617 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | MN |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Nurse Practitioner |
Taxonomy Specialization: | Adult Health |
Taxonomy Definition: |