Individual
JENNIFER FULLER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
9618 N 36TH ST, PHOENIX, AZ 85028-4938
(480) 466-6699
Mailing address
9618 N 36TH ST, PHOENIX, AZ 85028-4938
Taxonomy
Speciality
Code
Description
License number
State
163WS0200X
School Registered Nurse
Primary
RN170543
AZ
Other
Enumeration date
12/11/2015
Last updated
12/11/2015
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