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NPI Code Detail

MEDICARE: LORI ANTOINETTE FULLER PA-C

MEDICARE: LORI ANTOINETTE FULLER PA-C
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363A00000XPhysician Assistant000850IA
2363AM0700XMedical Physician Assistant000850IA
3363AS0400XSurgical Physician Assistant000850IA

General Provider Information

NPI Number : 1588643811
Entity Type Code : Individual
Provider Name (Legal Business Name) : LORI ANTOINETTE FULLER PA-C
Provider Business Mailing Address
First Line : 200 HAWKINS DR
Second Line :
City : IOWA CITY
State : IA
Zip : 52242-1009
Country : US
Telephone Number : 319-335-3500
Fax Number : 319-353-7331
Provider Business Practice Location Address
First Line : 200 HAWKINS DR
Second Line :
City : IOWA CITY
State : IA
Zip : 52242-1009
Country : US
Telephone Number : 319-335-3500
Fax Number : 319-353-7331
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/13/2006
Last Update Date : 12/17/2021

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Directions to “ LORI ANTOINETTE FULLER PA-C” Practice Location

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