Healthcare Provider Details

I. General information

NPI: 1316352065
Provider Name (Legal Business Name): CATHERINE FULLER APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/20/2014
Last Update Date: 07/01/2026
Certification Date: 07/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3033 N CARSON ST
CARSON CITY NV
89706-0153
US

IV. Provider business mailing address

1397 COPPER HILL AVE
CARSON CITY NV
89703-2361
US

V. Phone/Fax

Practice location:
  • Phone: 775-671-5814
  • Fax:
Mailing address:
  • Phone: 775-671-5814
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN001764
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: