Provider Demographics
NPI:1083477178
Name:FULLER, CIERRA
Entity Type:Individual
Prefix:
First Name:CIERRA
Middle Name:
Last Name:FULLER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:415 LOCUST ST
Mailing Address - Street 2:
Mailing Address - City:LOCKLAND
Mailing Address - State:OH
Mailing Address - Zip Code:45215-2813
Mailing Address - Country:US
Mailing Address - Phone:513-477-6310
Mailing Address - Fax:
Practice Address - Street 1:415 LOCUST ST
Practice Address - Street 2:
Practice Address - City:LOCKLAND
Practice Address - State:OH
Practice Address - Zip Code:45215-2813
Practice Address - Country:US
Practice Address - Phone:513-477-6310
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-01
Last Update Date:2024-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes372500000XNursing Service Related ProvidersChore Provider