Individual
MRS. KATHLEEN MARIE FULLER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
300 CONGRESS ST, SUITE 102, QUINCY, MA 02169-0907
(617) 479-6636
(617) 376-0435
Mailing address
300 CONGRESS ST, SUITE 102, QUINCY, MA 02169-0907
(617) 471-1161
(617) 376-0435
Taxonomy
Speciality
Code
Description
License number
State
363LX0001X
Obstetrics & Gynecology Nurse Practitioner
Primary
RN2297885
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
RN2297885
NURSE PRACTITIONER LICENSE
MA
Enumeration date
04/12/2006
Last updated
11/22/2016
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