MEDICARE: AMY RUPP FULLER D.V.M.

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
1	174M00000X	Veterinarian	7041	CO

General Provider Information

NPI Number	:	1649554213
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMY RUPP FULLER D.V.M.

Provider Business Mailing Address
First Line	:	2899 N SPEER BLVD UNIT 104
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80211-4217
Country	:	US
Telephone Number	:	303-477-1984
Fax Number	:

Provider Business Practice Location Address
First Line	:	2899 N SPEER BLVD UNIT 104
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80211-4217
Country	:	US
Telephone Number	:	303-477-1984
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/30/2011
Last Update Date	:	09/30/2011

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