| NPI | 1891247748 |
|---|---|
| Former Name | MANDY MARIE FULLINGTON |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LG0600X Nurse Practitioner, Gerontology (Licence: IN 71006822A) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: IN 71006822A) |
| Enumeration Date | 2016-10-26 |
| Last Update Date | 2024-05-29 |