| NPI | 1518102995 |
|---|---|
| Former Name | JENNIFER LORAYNE FULLER |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207LP3000X Anesthesiology, Pediatric Anesthesiology (Licence: CA A102931) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: CA A102931) |
| Enumeration Date | 2008-12-12 |
| Last Update Date | 2018-08-01 |