Individual
MRS. ELIZABETH J. FULLER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MSN, RN, CNS
Contact information
Practice address
1633 N CAPITOL AVE, SUITE 436, INDIANAPOLIS, IN 46202-1261
(317) 962-6603
(317) 962-2049
Mailing address
250 N SHADELAND AVE, INDIANAPOLIS, IN 46219-4959
Taxonomy
Speciality
Code
Description
License number
State
364SA2200X
Adult Health Clinical Nurse Specialist
Primary
28090249A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
28090249A
STATE LICENSE
IN
Enumeration date
03/13/2007
Last updated
01/21/2021
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