Doctor Name: | ANNE B FULLMER |
NPI Number: | 1891165569 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | FNP |
License Number: | N-38467 |
Business Practice Address: | 709 N Lincoln Ave Jerome, ID - 833381851 |
Business Phone Number: | 2088149772 |
Business Fax Number: | |
Mailing Address: | 709 N Lincoln Ave, JEROME |
State: | ID |
Postal Code: | 833381851 |
Phone Number: | 2088149772 |
Fax Number: | |
NPI Enumeration Date: | 10/06/2015 |
NPI Last Update Date: | 10/06/2015 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363LF0000X |
License Number: | N-38467 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | ID |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Nurse Practitioner |
Taxonomy Specialization: | Family |
Taxonomy Definition: |