Individual
MICHELLE FULLER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
APN
Contact information
Practice address
1415 E STATE ST, ROCKFORD, IL 61104-2333
(779) 696-4891
(779) 696-5312
Mailing address
PO BOX 78866, MILWAUKEE, WI 53278-8866
(779) 696-7150
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
209-012872
IL
Other
Enumeration date
06/23/2015
Last updated
02/06/2024
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