Individual
NATHANAEL KEITH FULLER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA
Contact information
Practice address
1550 6TH STREET, MANNING, IA 51455-1004
(712) 655-2072
(712) 655-3228
Mailing address
1550 6TH ST, MANNING, IA 51455-1005
(712) 655-2072
(712) 655-3228
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
002297
IA
Other
Enumeration date
06/21/2012
Last updated
06/13/2014
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