Provider Demographics
NPI:1659428209
Name:FULLER, ANNE ELIZABETH (MPAS, PA-C)
Entity Type:Individual
Prefix:MISS
First Name:ANNE
Middle Name:ELIZABETH
Last Name:FULLER
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Gender:F
Credentials:MPAS, PA-C
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Mailing Address - Street 1:1853 OCONNELL BLVD
Mailing Address - Street 2:BLDG. 1042
Mailing Address - City:FORT CARSON
Mailing Address - State:CO
Mailing Address - Zip Code:80913-4055
Mailing Address - Country:US
Mailing Address - Phone:719-524-5572
Mailing Address - Fax:
Practice Address - Street 1:1853 OCONNELL BLVD
Practice Address - Street 2:BLDG. 1042
Practice Address - City:FORT CARSON
Practice Address - State:CO
Practice Address - Zip Code:80913-4055
Practice Address - Country:US
Practice Address - Phone:719-524-5572
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-05
Last Update Date:2013-08-21
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant