Provider Demographics
NPI:1063859437
Name:FULLER, ADRIA (LDM, CPM, LM)
Entity Type:Individual
Prefix:
First Name:ADRIA
Middle Name:
Last Name:FULLER
Suffix:
Gender:F
Credentials:LDM, CPM, LM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 984
Mailing Address - Street 2:
Mailing Address - City:HOOD RIVER
Mailing Address - State:OR
Mailing Address - Zip Code:97031-0033
Mailing Address - Country:US
Mailing Address - Phone:509-637-0816
Mailing Address - Fax:
Practice Address - Street 1:408 CASCADE AVE UNIT 984
Practice Address - Street 2:
Practice Address - City:HOOD RIVER
Practice Address - State:OR
Practice Address - Zip Code:97031-0823
Practice Address - Country:US
Practice Address - Phone:509-637-0816
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-25
Last Update Date:2014-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife