Individual
MR. KEVIN POWELL FULLER I
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
1839 ZARKER ST, HARRISBURG, PA 17104-1351
(717) 379-2546
Mailing address
1839 ZARKER ST, HARRISBURG, PA 17104-1351
(717) 379-2546
Taxonomy
Speciality
Code
Description
License number
State
374U00000X
Home Health Aide
Primary
271077801
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
271077801
—
PA
Enumeration date
10/09/2009
Last updated
10/09/2009
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