Individual
LAKESHIA RENA FULLER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
RN
Contact information
Practice address
14214 WRANGLER WAY, DALLAS, TX 75253-4954
(469) 632-2872
Mailing address
14214 WRANGLER WAY, DALLAS, TX 75253-4954
(469) 632-2872
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
940543
TX
Other
Enumeration date
06/11/2020
Last updated
06/11/2020
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