Individual
DEWASKIE FULLER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
122 KYLE ST, NATCHITOCHES, LA 71457-3686
(318) 518-5542
Mailing address
122 KYLE ST, NATCHITOCHES, LA 71457
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
—
—
Other
Enumeration date
12/29/2015
Last updated
01/14/2019
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