Individual
TRACEY L FULLER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1255 S MONROE AVE STE 102, GREEN BAY, WI 54301-3054
(920) 246-9710
Mailing address
1255 S MONROE AVE STE 102, GREEN BAY, WI 54301-3054
(920) 246-9710
Taxonomy
Speciality
Code
Description
License number
State
335E00000X
Prosthetic/Orthotic Supplier
Primary
—
—
Other
Enumeration date
02/05/2025
Last updated
02/05/2025
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