Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363L00000X | Nurse Practitioner | 200909 | NC |
NPI | 1013082288 |
---|---|
Provider Name | Dr. Susan A Fuller |
First Address | Asheboro, NC 27204-2005 |
Second Address | Asheboro, NC 27205-1066 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 22/11/2006 |
Last Update Date | 20/09/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
7003515 | (05) | NC |