Organization
DIXIE A. FULLERTON
Active
Other names
Carefree Footwear
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. DIXIE A FULLERTON (OWNER)
(702) 384-5121
Entity
Organization
Contact information
Practice address
1618 E CHARLESTON BLVD, LAS VEGAS, NV 89104-1826
(702) 384-5121
(702) 384-4416
Mailing address
1618 E CHARLESTON BLVD, LAS VEGAS, NV 89104-1826
(702) 384-5121
(702) 384-4416
Taxonomy
Speciality
Code
Description
License number
State
335E00000X
Prosthetic/Orthotic Supplier
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
003302425
—
NV
Enumeration date
01/05/2007
Last updated
07/23/2012
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