| NPI | 1487961231 |
|---|---|
| Former Name | TRACI ANN FULLER |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: OH 50003781) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: GA 006385) |
| 363AS0400X Physician Assistant, Surgical (Licence: GA 006385) | |
| Enumeration Date | 2010-08-31 |
| Last Update Date | 2013-06-21 |