Provider Demographics
NPI:1831710987
Name:FULLER, MARGARET MAEVE (PMHNP)
Entity type:Individual
Prefix:MRS
First Name:MARGARET
Middle Name:MAEVE
Last Name:FULLER
Suffix:
Gender:F
Credentials:PMHNP
Other - Prefix:MS
Other - First Name:MARGARET
Other - Middle Name:MAEVE
Other - Last Name:WHITE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:201 S MARKET ST
Mailing Address - Street 2:
Mailing Address - City:OTTUMWA
Mailing Address - State:IA
Mailing Address - Zip Code:52501-2946
Mailing Address - Country:US
Mailing Address - Phone:641-683-5773
Mailing Address - Fax:
Practice Address - Street 1:201 S MARKET ST
Practice Address - Street 2:
Practice Address - City:OTTUMWA
Practice Address - State:IA
Practice Address - Zip Code:52501-2946
Practice Address - Country:US
Practice Address - Phone:641-683-5773
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-04-29
Last Update Date:2020-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAG157788363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health