Individual
MISS TERRELL A FULLER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LPN
Contact information
Practice address
561 IRVINGTON AVE, NEWARK, NJ 07106-3103
(973) 373-0387
Mailing address
850 STEPHENSON HWY STE 612, TROY, MI 48083-1127
(888) 451-2519
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
LP53855
MD
Other
Enumeration date
05/05/2023
Last updated
05/05/2023
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