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General NPI Number Information
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NPI Number | 1194600361
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Entity Type | Individual
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Provider Name | MATTHEW JOHN FULLERTON STNA
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Gender | Male
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Dates
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Enumeration Date | 08/07/2025
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Last Update Date | 08/07/2025
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Provider Practice Location Address
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Address Line | 2445 COLUMBUS-LANCASTER RD NW LOT 475
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City | LANCASTER
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State | OH
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Zip | 43130
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Country | US
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Telephone | 740-277-6293
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Fax |
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Provider Business Mailing Address
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Address Line | 27137 STUART ROAD
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City | ROCKBRIDGE
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State | OH
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Zip | 43149
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Country | US
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Telephone | 740-583-0902
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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 | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number | 401984010717
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License Number State | OH
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