Individual
LORI ANTOINETTE FULLER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
200 HAWKINS DR, IOWA CITY, IA 52242-1009
(319) 335-3500
(319) 353-7331
Mailing address
200 HAWKINS DR, IOWA CITY, IA 52242-1009
(319) 335-3500
(319) 353-7331
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
000850
IA
363AM0700X
Medical Physician Assistant
000850
IA
363AS0400X
Surgical Physician Assistant
Primary
000850
IA
Other
Enumeration date
01/13/2006
Last updated
12/17/2021
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