Organization
FULLER PRIMARY CARE PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SUSAN A FULLER FNP (PRESIDENT)
(336) 382-9494
Entity
Organization
Contact information
Practice address
5405 FRIEDENS CHURCH ROAD, MCLEANSVILLE, NC 27301-0459
(336) 382-9494
(336) 697-1580
Mailing address
PO BOX 459, MC LEANSVILLE, NC 27301-0459
(336) 697-1550
(336) 697-1580
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
200909
NC
Other
Enumeration date
04/21/2009
Last updated
08/05/2009
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