Individual
DEUNDRA DENISE FULLER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
CPSS
Contact information
Practice address
279 SUMMIT DR, WATERFORD, MI 48328-3364
(248) 409-4139
Mailing address
279 SUMMIT DR, WATERFORD, MI 48328-3364
(248) 409-4139
Taxonomy
Speciality
Code
Description
License number
State
175T00000X
Peer Specialist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
175T00000X
—
MI
Enumeration date
02/14/2020
Last updated
02/14/2020
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