Doctor Name: | MRS. GLORIA FULLER |
NPI Number: | 1245460625 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | FNP |
License Number: | 694365 |
Business Practice Address: | 1619 4th Ave Canyon, TX - 790153824 |
Business Phone Number: | 8065574138 |
Business Fax Number: | 8065574165 |
Mailing Address: | 1619 4th Ave, CANYON |
State: | TX |
Postal Code: | 790153824 |
Phone Number: | 8065574138 |
Fax Number: | 8065574165 |
NPI Enumeration Date: | 07/21/2009 |
NPI Last Update Date: | 12/17/2013 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363LF0000X |
License Number: | 694365 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | TX |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Nurse Practitioner |
Taxonomy Specialization: | Family |
Taxonomy Definition: |