Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207XX0004X | Foot and Ankle Orthopaedic Surgeon | PENDING | MO |
NPI | 1689339343 |
---|---|
Provider Name | Lauren Nicole Fuller |
First Address | Columbia, MO 65203-6648 |
Second Address | Columbia, MO 65201-7199 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/11/2021 |
Last Update Date | 07/11/2021 |