Individual
MRS. LYNNETTE SUE FULLER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
81 N MARIO CAPECCHI DR, SALT LAKE CITY, UT 84113-1125
(801) 213-3599
(801) 587-7539
Mailing address
295 CHIPETA WAY, SALT LAKE CITY, UT 84108-1220
(801) 213-3599
(801) 587-7539
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
4553606-1206
UT
Other
Enumeration date
02/22/2007
Last updated
12/17/2021
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