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1013577667
MICHAEL FULLER
MAYFIELD, KY
NPI
1013577667
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
No
Primary Taxonomy
164W00000X Licensed Practical Nurse
(Licence: TN LPN0000092565)
Enumeration Date
2019-06-17
Last Update Date
2019-06-17
Business Address
MICHAEL FULLER LPN
1539 CUBA RD
MAYFIELD, KY 42066-6809
Phone number: 270-251-2924
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Mailing Address
MICHAEL FULLER LPN
425 BROADWAY ST STE 201
PADUCAH, KY 42001-0713
Phone number: 270-442-7121
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