Individual
HEIDI MARIE FULLER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
CRNA
Contact information
Practice address
22 BRAMHALL ST, PORTLAND, ME 04102-3134
(207) 662-2911
Mailing address
716 STEVENS AVE, PORTLAND, ME 04103-2656
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
RNA193020
ME
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
06/06/2017
Last updated
09/24/2019
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