Individual
ARIZONA DANIELLE FULLER I
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
4342 GALLIA ST STE A, PORTSMOUTH, OH 45662-5563
(740) 820-9708
Mailing address
11671 GALLIA PIKE RD, WHEELERSBURG, OH 45694-8441
(740) 727-9424
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
—
—
Other
Enumeration date
06/30/2020
Last updated
06/30/2020
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