Healthcare Provider Details

I. General information

NPI: 1649554213
Provider Name (Legal Business Name): AMY RUPP FULLER D.V.M.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/30/2011
Last Update Date: 09/30/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2899 N SPEER BLVD UNIT 104
DENVER CO
80211-4217
US

IV. Provider business mailing address

2899 N SPEER BLVD UNIT 104
DENVER CO
80211-4217
US

V. Phone/Fax

Practice location:
  • Phone: 303-477-1984
  • Fax:
Mailing address:
  • Phone: 303-477-1984
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174M00000X
TaxonomyVeterinarian
License Number7041
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: