Provider Demographics
NPI:1801413455
Name:FULLER, ARIZONA DANIELLE I
Entity Type:Individual
Prefix:
First Name:ARIZONA
Middle Name:DANIELLE
Last Name:FULLER
Suffix:I
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 1:11671 GALLIA PIKE RD
Mailing Address - Street 2:
Mailing Address - City:WHEELERSBURG
Mailing Address - State:OH
Mailing Address - Zip Code:45694-8441
Mailing Address - Country:US
Mailing Address - Phone:740-727-9424
Mailing Address - Fax:
Practice Address - Street 1:4342 GALLIA ST STE A
Practice Address - Street 2:
Practice Address - City:PORTSMOUTH
Practice Address - State:OH
Practice Address - Zip Code:45662-5563
Practice Address - Country:US
Practice Address - Phone:740-820-9708
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-30
Last Update Date:2020-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator