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Individual
ELAINE TERESA FULLER
Active
Individual
ELAINE TERESA FULLER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
282
SC
363A00000X
Physician Assistant
Primary
283
SC
363AM0700X
Medical Physician Assistant
283
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0279PA
—
SC
01
—
576007863095
BCBS OF SC
SC
01
—
P00182170
RR MEDICARE
SC
01
—
P00801539
RR MEDICARE
SC
Enumeration date
06/05/2006
Last updated
06/30/2021
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