Individual
CARMELLA L FULLENWIDER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
AG-PCNP-BC
Contact information
Practice address
645 NW 4TH ST, REDMOND, OR 97756-1502
(541) 389-7741
Mailing address
PO BOX 1517, PENDLETON, OR 97801-0410
(541) 278-4332
(541) 278-8349
Taxonomy
Speciality
Code
Description
License number
State
363LP2300X
Primary Care Nurse Practitioner
Primary
10027848
OR
Other
Enumeration date
06/17/2024
Last updated
06/28/2024
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