Individual
DANIEL BOSTON FULLER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
620 JOHN PAUL JONES CIR, PORTSMOUTH, VA 23708-2111
(828) 230-4102
Mailing address
620 JOHN PAUL JONES CIR, PORTSMOUTH, VA 23708-2111
(828) 230-4102
Taxonomy
Speciality
Code
Description
License number
State
363LA2100X
Acute Care Nurse Practitioner
Primary
0024171194
VA
364SA2100X
Acute Care Clinical Nurse Specialist
0024171194
VA
Other
Enumeration date
09/14/2013
Last updated
02/02/2022
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