JACOB DEAN FULLER

SPRINGFIELD, OR
NPI1720423536
Entity TypeIndividual
GenderMale
Sole Proprietor ?Yes
Primary Taxonomy164W00000X Licensed Practical Nurse
(Licence: OR  201230678LPN)
Additional Taxonomies164W00000X Licensed Practical Nurse
(Licence: WV  28704)
Enumeration Date2013-05-07
Last Update Date2013-05-07
Business Address
Mr. JACOB DEAN FULLER LPN
3333 RIVERBEND DR
SPRINGFIELD, OR 97477-8800
Phone number: 877-350-7430
Mailing Address
Mr. JACOB DEAN FULLER LPN
585 36TH ST
SPRINGFIELD, OR 97478-5789
Phone number: 541-513-5518