Provider Demographics
NPI:1205626983
Name:FULLER, TYRESHIA
Entity type:Individual
Prefix:
First Name:TYRESHIA
Middle Name:
Last Name:FULLER
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1347 Y ST
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68107-3562
Mailing Address - Country:US
Mailing Address - Phone:531-215-5820
Mailing Address - Fax:
Practice Address - Street 1:1347 Y ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68107-3562
Practice Address - Country:US
Practice Address - Phone:531-215-5820
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-07
Last Update Date:2025-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide