| NPI | 1407033012 |
|---|---|
| Former Name | MELISSA A FULLNER |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant Medical (Licence: SD 1222) |
| Additional Taxonomies | 363AM0700X Physician Assistant Medical (Licence: NE 1632) |
| 363AM0700X Physician Assistant Medical (Licence: SD 0667) | |
| Enumeration Date | 2008-01-25 |
| Last Update Date | 2020-06-24 |