Individual
MRS. PAMELA MARY FULLER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
RN
Contact information
Practice address
1620 44TH ST SE, GRAND RAPIDS, MI 49508-5002
(616) 243-6262
(616) 243-6969
Mailing address
1620 44TH ST SE, GRAND RAPIDS, MI 49508-5002
(616) 243-6262
(616) 243-6969
Taxonomy
Speciality
Code
Description
License number
State
163WA0400X
Addiction (Substance Use Disorder) Registered Nurse
Primary
4704188418
MI
Other
Enumeration date
08/06/2019
Last updated
08/06/2019
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