Individual
NICOLE MIDDLETON FULLER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP-C
Contact information
Practice address
2516 BROADMOOR BLVD, MONROE, LA 71201-2988
(318) 322-1161
(318) 322-9313
Mailing address
130 DESIARD ST STE 355, MONROE, LA 71201-7363
(318) 807-7875
(318) 812-6603
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
AP04408
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1473286
—
LA
01
—
P00625589
RR MEDICARE
LA
Enumeration date
03/01/2007
Last updated
12/29/2023
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