Individual
TERESA LORRAINE FULLER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DO
Contact information
Practice address
1801 HICKMAN RD, DES MOINES, IA 50314-1548
(515) 282-2200
Mailing address
2347 E 38TH CT, DES MOINES, IA 50317-5732
(515) 452-5792
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
R-12561
IA
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
05/10/2022
Last updated
05/31/2022
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