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General NPI Number Information
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NPI Number | 1538520002
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Entity Type | Individual
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Provider Name | LATONYA FULLER
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Gender | Female
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Dates
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Enumeration Date | 03/11/2016
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Last Update Date | 03/11/2016
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Provider Practice Location Address
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Address Line | 27578 SCHOOLCRAFT RD
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City | LIVONIA
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State | MI
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Zip | 48150-2203
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Country | US
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Telephone | 734-744-9667
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Fax | 734-744-9668
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Provider Business Mailing Address
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Address Line | 12829 LEVERNE
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City | REDFORD
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State | MI
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Zip | 48239-2732
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Country | US
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Telephone | 734-744-9667
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Fax | 734-744-9668
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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 | 343900000X
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Taxonomy Name | Non-emergency Medical Transport (VAN)
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License Number |
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License Number State |
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