Provider Demographics
NPI:1891726337
Name:FULLER, NANCY MARIE (NP)
Entity Type:Individual
Prefix:MRS
First Name:NANCY
Middle Name:MARIE
Last Name:FULLER
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Gender:F
Credentials:NP
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Mailing Address - Street 1:913 NW GARDEN VALLEY BLVD
Mailing Address - Street 2:VA ROSEBURG HEALTHCARE SYSTEM
Mailing Address - City:ROSEBURG
Mailing Address - State:OR
Mailing Address - Zip Code:97471-6523
Mailing Address - Country:US
Mailing Address - Phone:541-440-1000
Mailing Address - Fax:541-440-1230
Practice Address - Street 1:913 NW GARDEN VALLEY BLVD
Practice Address - Street 2:VA ROSEBURG HEALTHCARE SYSTEM
Practice Address - City:ROSEBURG
Practice Address - State:OR
Practice Address - Zip Code:97471-6523
Practice Address - Country:US
Practice Address - Phone:541-440-1000
Practice Address - Fax:541-440-1230
Is Sole Proprietor?:No
Enumeration Date:2006-07-05
Last Update Date:2013-06-19
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Provider Licenses
StateLicense IDTaxonomies
IL209-003019363LA2200X
OR201050069NP363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health