Provider Demographics
NPI:1316188592
Name:PIERCE-FULLER, ANITA CHRISTINE (LVN)
Entity Type:Individual
Prefix:MRS
First Name:ANITA
Middle Name:CHRISTINE
Last Name:PIERCE-FULLER
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1625 CARROLL AVE
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94124-3219
Mailing Address - Country:US
Mailing Address - Phone:415-822-8200
Mailing Address - Fax:415-822-6822
Practice Address - Street 1:1625 CARROLL AVE
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94124-3219
Practice Address - Country:US
Practice Address - Phone:415-822-8200
Practice Address - Fax:415-822-6822
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-17
Last Update Date:2009-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAVN145864164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse