Individual
MS. TERIA JO FULLER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RN
Contact information
Practice address
908 20TH ST S, BIRMINGHAM, AL 35205-2610
(205) 934-0712
Mailing address
908 20TH ST S RM 487, BIRMINGHAM, AL 35205-2610
(205) 934-9715
(205) 975-8950
Taxonomy
Speciality
Code
Description
License number
State
163WP0809X
Adult Psychiatric/Mental Health Registered Nurse
Primary
1-091343
AL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1041C0700X
—
AL
Enumeration date
11/28/2017
Last updated
11/28/2017
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