Healthcare Provider Details

I. General information

NPI: 1982230199
Provider Name (Legal Business Name): SARAH MARIE FULLER NP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/19/2020
Last Update Date: 03/19/2020
Certification Date: 03/19/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2000 ROCKFORD RD
CHARLES CITY IA
50616-9101
US

IV. Provider business mailing address

2000 ROCKFORD RD
CHARLES CITY IA
50616-9101
US

V. Phone/Fax

Practice location:
  • Phone: 641-257-3496
  • Fax: 641-257-3291
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number121067
License Number StateIA
# 2
Primary TaxonomyY
Taxonomy Code363LX0106X
TaxonomyOccupational Health Nurse Practitioner
License NumberA157279
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: