Provider Demographics
NPI:1841738804
Name:FULLER, SHARON ESTER
Entity type:Individual
Prefix:MS
First Name:SHARON
Middle Name:ESTER
Last Name:FULLER
Suffix:
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 1:425 N BRUSH ST
Mailing Address - Street 2:
Mailing Address - City:FREMONT
Mailing Address - State:OH
Mailing Address - Zip Code:43420-1455
Mailing Address - Country:US
Mailing Address - Phone:419-341-7809
Mailing Address - Fax:
Practice Address - Street 1:225 JEFFERSON ST
Practice Address - Street 2:APT 5
Practice Address - City:PORT CLINTON
Practice Address - State:OH
Practice Address - Zip Code:43452-1157
Practice Address - Country:US
Practice Address - Phone:419-341-7809
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-02-09
Last Update Date:2020-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide