Individual
MELINDA S FULLER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNP
Contact information
Practice address
2350 FREEDOM WAY, SUITE 202, YORK, PA 17402-8200
(717) 851-2465
(717) 741-3043
Mailing address
3421 CONCORD RD, YORK, PA 17402-9001
(717) 851-2465
(717) 741-3043
Taxonomy
Speciality
Code
Description
License number
State
363LA2100X
Acute Care Nurse Practitioner
Primary
SP011669
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1605971
GATEWAY MEDICARE ASSURED
PA
01
—
2682788
HIGHMARK BLUE SHIELD - FREEDOM BLUE
PA
Enumeration date
12/06/2011
Last updated
06/13/2016
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