Individual
MELISSA A FULLNER-MARSHALL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
1104 W 8TH ST, YANKTON, SD 57078-3306
(605) 665-7841
(605) 665-0546
Mailing address
1104 W 8TH ST, YANKTON, SD 57078-3306
(605) 665-7841
(605) 665-0546
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
0667
SD
363AM0700X
Medical Physician Assistant
Primary
1222
SD
363AM0700X
Medical Physician Assistant
1632
NE
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
10025938900
—
NE
05
—
6830000
—
SD
Enumeration date
01/25/2008
Last updated
06/24/2020
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