Individual
NATHAN FULLEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
7353 REEDY CREEK RD, BRISTOL, VA 24202-1911
(423) 534-3220
Mailing address
314 HAMILTON ST APT 1, JOHNSON CITY, TN 37604-6838
(423) 557-4765
Taxonomy
Speciality
Code
Description
License number
State
374U00000X
Home Health Aide
Primary
—
TN
Other
Enumeration date
01/27/2023
Last updated
01/27/2023
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