Individual
EDWARD K FULLER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
7160 RAFAEL RIVERA WAY STE 210, LAS VEGAS, NV 89113-5395
(702) 878-0070
(702) 805-0307
Mailing address
PO BOX 840857, DALLAS, TX 75284-0857
(725) 204-4632
(702) 805-0307
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
848145
NV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
136145
—
AZ
05
—
250023986
—
NV
Enumeration date
07/03/2006
Last updated
10/20/2023
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