Provider Demographics
NPI:1710748447
Name:FULLER, ASHLEN ELIZABETH
Entity Type:Individual
Prefix:
First Name:ASHLEN
Middle Name:ELIZABETH
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 1:1163 GRANDVIEW AVE SW
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44710-1409
Mailing Address - Country:US
Mailing Address - Phone:330-704-8905
Mailing Address - Fax:
Practice Address - Street 1:1163 GRANDVIEW AVE SW
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:OH
Practice Address - Zip Code:44710-1409
Practice Address - Country:US
Practice Address - Phone:330-704-8905
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-19
Last Update Date:2024-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide