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Individual

NANCY S. FULLER

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
M.D.

Contact information

Practice address
700 S PARK ST, MADISON, WI 53715-1830
(608) 251-6100
Mailing address
700 S PARK ST, MADISON, WI 53715-1830
(608) 251-6100

Taxonomy

Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
54479-20
WI
208M00000X
Hospitalist Physician
Primary
54479-20
WI

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
61039
DEAN HEALTH INSURANCE
WI
Enumeration date
03/21/2007
Last updated
01/20/2011
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