Individual
MS. LORI ANN FULLER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
RN
Contact information
Practice address
4088 W HAWTHORNE TRACE RD APT 209, BROWN DEER, WI 53209-1017
(414) 759-8582
Mailing address
4088 W HAWTHORNE TRACE RD APT 209, BROWN DEER, WI 53209-1017
(414) 759-8582
Taxonomy
Speciality
Code
Description
License number
State
163WH0200X
Home Health Registered Nurse
Primary
110555-30
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
39872800
—
WI
Enumeration date
11/16/2007
Last updated
08/11/2011
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