Individual
SARA G FULLER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
2638 TWO NOTCH RD, SUITE 110, COLUMBIA, SC 29204-1454
(803) 256-2500
(803) 255-3451
Mailing address
15 MEDICAL PARK RD, SUITE 300, COLUMBIA, SC 29203-8003
(803) 255-3422
(803) 255-3451
Taxonomy
Speciality
Code
Description
License number
State
363LP0200X
Pediatric Nurse Practitioner
Primary
APN1042
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
NP0171
—
SC
Enumeration date
05/18/2006
Last updated
10/10/2008
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