Individual
HEIDI FULLER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
12121 SHELBYVILLE RD STE 101, LOUISVILLE, KY 40243-1094
(502) 341-1599
Mailing address
12121 SHELBYVILLE RD STE 101, LOUISVILLE, KY 40243-1094
(502) 341-1599
Taxonomy
Speciality
Code
Description
License number
State
305S00000X
Point of Service
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000965136
CRANIAL PROSTHESIS
KY
01
—
965136
MEDICAL SERVICES
—
Enumeration date
02/25/2020
Last updated
02/25/2020
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