Individual
AUGUSTUS FULLER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
6238 N 155TH AVE, OMAHA, NE 68116-4449
(402) 739-1337
Mailing address
9744 MOCKINGBIRD DR, OMAHA, NE 68127-2013
(402) 800-3787
Taxonomy
Speciality
Code
Description
License number
State
372600000X
Adult Companion
Primary
—
—
Other
Enumeration date
03/24/2025
Last updated
03/24/2025
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