Provider Demographics
NPI:1235559121
Name:FULLER, AMY MARGARET (DNP, WHNP-BC, RNC)
Entity Type:Individual
Prefix:DR
First Name:AMY
Middle Name:MARGARET
Last Name:FULLER
Suffix:
Gender:F
Credentials:DNP, WHNP-BC, RNC
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:147 MILK ST
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02109-4806
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:34 BAYVIEW AVE
Practice Address - Street 2:
Practice Address - City:DANVERS
Practice Address - State:MA
Practice Address - Zip Code:01923-3214
Practice Address - Country:US
Practice Address - Phone:339-226-0124
Practice Address - Fax:671-421-5828
Is Sole Proprietor?:No
Enumeration Date:2014-04-18
Last Update Date:2020-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN234627363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health