MEDICARE: QUINETTA S FULLER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	374U00000X	Home Health Aide
2	253Z00000X	In Home Supportive Care Agency

General Provider Information

NPI Number	:	1396620217
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	QUINETTA S FULLER

Provider Business Mailing Address
First Line	:	11100 SAINT MARK AVE
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44111-3781
Country	:	US
Telephone Number	:	334-304-8096
Fax Number	:	334-304-8096

Provider Business Practice Location Address
First Line	:	11100 SAINT MARK AVE
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44111-3781
Country	:	US
Telephone Number	:	334-304-8096
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/08/2025
Last Update Date	:	08/08/2025

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Directions to “ QUINETTA S FULLER ” Practice Location

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