1235559121 NPI number — DR. AMY MARGARET FULLER DNP, WHNP-BC, RNC

Table of content: DR. AMY MARGARET FULLER DNP, WHNP-BC, RNC (NPI 1235559121)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1235559121 NPI number — DR. AMY MARGARET FULLER DNP, WHNP-BC, RNC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
FULLER
Provider First Name:
AMY
Provider Middle Name:
MARGARET
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DNP, WHNP-BC, RNC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1235559121
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/25/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
147 MILK ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BOSTON
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
02109-4806
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
34 BAYVIEW AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DANVERS
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
01923-3214
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
339-226-0124
Provider Business Practice Location Address Fax Number:
671-421-5828
Provider Enumeration Date:
04/18/2014

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LW0102X , with the licence number:  RN234627 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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