Provider Demographics
NPI:1003822701
Name:FULLER, JANELL (MD)
Entity Type:Individual
Prefix:
First Name:JANELL
Middle Name:
Last Name:FULLER
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:2211 LOMAS BLVD NE
Mailing Address - Street 2:MSC10 5590
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87131-0001
Mailing Address - Country:US
Mailing Address - Phone:505-272-2345
Mailing Address - Fax:
Practice Address - Street 1:3RD AMBULATORY CARE CTR
Practice Address - Street 2:2211 LOMAS BLVD. NE
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87131-0001
Practice Address - Country:US
Practice Address - Phone:505-272-2345
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-01
Last Update Date:2023-09-13
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NM2004-02322080N0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080N0001XAllopathic & Osteopathic PhysiciansPediatricsNeonatal-Perinatal Medicine