Provider Demographics
NPI:1235277286
Name:FULLER, DONNA (BS)
Entity Type:Individual
Prefix:
First Name:DONNA
Middle Name:
Last Name:FULLER
Suffix:
Gender:F
Credentials:BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:NANCE WHITE BRANCH
Mailing Address - Street 2:ROUTE 2 BOX 473 B
Mailing Address - City:HONAKER
Mailing Address - State:VA
Mailing Address - Zip Code:24260
Mailing Address - Country:US
Mailing Address - Phone:276-859-0010
Mailing Address - Fax:
Practice Address - Street 1:138 PARK PLACE
Practice Address - Street 2:
Practice Address - City:CLITNWOOD
Practice Address - State:VA
Practice Address - Zip Code:24228-1449
Practice Address - Country:US
Practice Address - Phone:276-926-1684
Practice Address - Fax:276-926-6070
Is Sole Proprietor?:No
Enumeration Date:2007-02-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator