Individual
MRS. MARIA TERESA CERVANTES-FULLMER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP
Contact information
Practice address
3245 CHANNING WAY, IDAHO FALLS, ID 83404-7536
(208) 227-2790
(208) 227-2735
Mailing address
PO BOX 741716, ATLANTA, GA 30374-1716
Taxonomy
Speciality
Code
Description
License number
State
207RH0003X
Hematology & Oncology Physician
Primary
46717
ID
Other
Enumeration date
10/29/2018
Last updated
01/30/2020
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