Doctor Name: | MR. JACOB DEAN FULLER |
NPI Number: | 1720423536 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | LPN |
License Number: | 28704 |
Business Practice Address: | 3333 Riverbend Dr Springfield, OR - 974778800 |
Business Phone Number: | 8773507430 |
Business Fax Number: | |
Mailing Address: | 585 36th St, SPRINGFIELD |
State: | OR |
Postal Code: | 974785789 |
Phone Number: | 5415135518 |
Fax Number: | |
NPI Enumeration Date: | 05/07/2013 |
NPI Last Update Date: | 05/07/2013 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 164W00000X |
License Number: | 28704 |
Healthcare Provider Taxonomy: (Secondary) | N |
State: | WV |
Taxonomy Type: | Nursing Service Providers |
Taxonomy Classification: | Licensed Practical Nurse |
Taxonomy Specialization: | |
Taxonomy Definition: | An individual with post-high school vocational training and practical experience in the provision of nursing care at a level less than that required for certification as a Registered Nurse. Requirements for education, experience, licensure, and job responsibilities vary among the states. |