Individual
RACHAEL FULLER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
205 N EAST AVE, JACKSON, MI 49201-1753
(517) 205-4800
(313) 876-1305
Mailing address
1 FORD PL STE 3A, DETROIT, MI 48202-3450
(313) 874-4806
(313) 876-1305
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
4704346116
MI
363LF0000X
Family Nurse Practitioner
Primary
4704346116
MI
363LF0000X
Family Nurse Practitioner
F09221030
MI
Other
Enumeration date
10/28/2022
Last updated
02/06/2023
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