Individual
NINA L FULLER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
930 W SOUTHERN AVE, MESA, AZ 85210-4938
(480) 835-0857
Mailing address
930 W SOUTHERN AVE, MESA, AZ 85210-4938
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
SLP5621
AZ
Other
Enumeration date
10/12/2007
Last updated
10/12/2007
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