Individual
JUSTIN WAYNE FULLER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
1400 S DOBSON RD, MESA, AZ 85202-4707
(972) 761-5508
Mailing address
1400 S DOBSON RD, MESA, AZ 85202-4707
(972) 761-5508
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
264564
AZ
367500000X
Certified Registered Nurse Anesthetist
RN185391
AZ
Other
Enumeration date
08/03/2021
Last updated
10/26/2021
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