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General NPI Number Information
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NPI Number | 1114550761
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Entity Type | Individual
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Provider Name | LATOSHA FULLER
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Gender | Female
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Dates
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Enumeration Date | 02/21/2020
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Last Update Date | 02/21/2020
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Provider Practice Location Address
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Address Line | 1812 MADDOX ST
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City | RICHMOND
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State | VA
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Zip | 23223-3828
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Country | US
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Telephone | 804-986-7705
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Fax |
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Provider Business Mailing Address
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Address Line | 2307 N 25TH ST
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City | RICHMOND
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State | VA
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Zip | 23223-4125
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Country | US
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Telephone | 804-986-7705
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3747A0650X
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Taxonomy Name | Attendant Care Provider
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License Number |
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License Number State | VA
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