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Individual

JONALYN PASCUA FULLER

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
NP

Contact information

Practice address
2115 S FREMONT AVE STE 3300, SPRINGFIELD, MO 65804-2246
(417) 820-5200
Mailing address
2115 S FREMONT AVE STE 3300, SPRINGFIELD, MO 65804-2246
(417) 820-5200

Taxonomy

Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
2015021422
MO
363LG0600X
Gerontology Nurse Practitioner
Primary
2021043723
MO

Other

Enumeration date
12/08/2021
Last updated
10/10/2022
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