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Individual

ASHLEY FULLER

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
ARNP

Contact information

Practice address
925 S 4TH ST, CLINTON, IA 52732-5726
(563) 336-3000
Mailing address
500 W RIVER DR, DAVENPORT, IA 52801-1014
(563) 336-3000
(563) 336-3125

Taxonomy

Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
A-124228
IA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
1932193224
IA
05
PENDING
IL
Enumeration date
07/21/2015
Last updated
08/07/2015
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