Individual
TINA FULLER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LPN
Contact information
Practice address
340 S BROADVIEW ST, CAPE GIRARDEAU, MO 63703-5703
(573) 332-0416
(573) 335-2698
Mailing address
8206 FENDALE DR, SAINT LOUIS, MO 63123-3304
(573) 944-4271
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
2006025670
MO
Other
Enumeration date
01/31/2018
Last updated
02/07/2026
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