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General NPI Number Information
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NPI Number | 1710303060
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Entity Type | Individual
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Provider Name | ISAIAH D FULLER
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Gender | Male
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Dates
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Enumeration Date | 03/11/2014
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Last Update Date | 02/21/2017
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Provider Practice Location Address
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Address Line | 700 CHILDREN'S DR
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City | COLUMBUS
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State | OH
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Zip | 43205
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Country | US
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Telephone | 614-722-4200
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Fax |
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Provider Business Mailing Address
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Address Line | 700 CHILDREN'S DR
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City | COLUMBUS
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State | OH
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Zip | 43205
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Country | US
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Telephone | 614-722-4200
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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 | 367500000X
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Taxonomy Name | Certified Registered Nurse Anesthetist
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License Number | COA.15672-NA
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 367500000X
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Taxonomy Name | Certified Registered Nurse Anesthetist
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License Number | 22165
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License Number State | TN
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