Individual
MS. LORA A FULLER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LPN, LMT
Contact information
Practice address
15358 BRIARWOOD DR, PEOSTA, IA 52068-9755
(563) 599-6536
Mailing address
15358 BRIARWOOD DR, PEOSTA, IA 52068-9755
(563) 599-6536
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
P48266
IA
225700000X
Massage Therapist
Primary
006722
IA
Other
Enumeration date
07/16/2015
Last updated
07/16/2015
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