Healthcare Provider Details

I. General information

NPI: 1003892167
Provider Name (Legal Business Name): JULIA DARLENE FULLER C.R.N.A.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JULIA DARLENE DIMICK-FULLER C.R.N.A.

II. Dates (important events)

Enumeration Date: 12/21/2005
Last Update Date: 01/11/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

555 N DUKE ST
LANCASTER PA
17602-2250
US

IV. Provider business mailing address

555 N DUKE ST
LANCASTER PA
17602-2250
US

V. Phone/Fax

Practice location:
  • Phone: 717-544-7890
  • Fax: 717-544-7151
Mailing address:
  • Phone: 717-544-7890
  • Fax: 717-544-7151

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberRN321584L
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberRN-322584L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: