Individual
RAVEN STOUDAMIRE-FULLER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
4719 HUNTINGTON AVE, OMAHA, NE 68152-2527
(531) 251-9020
Mailing address
4719 HUNTINGTON AVE, OMAHA, NE 68152-2527
(531) 251-9020
Taxonomy
Speciality
Code
Description
License number
State
374U00000X
Home Health Aide
Primary
—
—
Other
Enumeration date
03/06/2025
Last updated
03/06/2025
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