Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 176B00000X | Midwife |
NPI | 1063859437 |
---|---|
Provider Name | Adria Fuller |
First Address | Hood River, OR 97031-0033 |
Second Address | Hood River, OR 97031-0823 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 25/05/2013 |
Last Update Date | 09/12/2014 |