Provider Demographics
NPI:1801809058
Name:FULLER, DOROTHY JANE (NP)
Entity type:Individual
Prefix:
First Name:DOROTHY
Middle Name:JANE
Last Name:FULLER
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:559 E ALISAL ST
Mailing Address - Street 2:SUITE 201
Mailing Address - City:SALINAS
Mailing Address - State:CA
Mailing Address - Zip Code:93905-2516
Mailing Address - Country:US
Mailing Address - Phone:831-769-8800
Mailing Address - Fax:831-422-9312
Practice Address - Street 1:559 E ALISAL ST
Practice Address - Street 2:SUITE 201
Practice Address - City:SALINAS
Practice Address - State:CA
Practice Address - Zip Code:93905-2516
Practice Address - Country:US
Practice Address - Phone:831-769-8800
Practice Address - Fax:831-422-9312
Is Sole Proprietor?:No
Enumeration Date:2006-08-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA135163163WP0200X
CA312363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered163WP0200XNursing Service ProvidersRegistered NursePediatrics
Not Answered363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAM0274138OtherDRIVER LICENSE