MEDICARE: MS. ESTHER MARIE FULLER M.S.C.P.

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	101Y00000X	Counselor		OK

General Provider Information

NPI Number	:	1811265234
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. ESTHER MARIE FULLER M.S.C.P.

Provider Business Mailing Address
First Line	:	7504 LYREWOOD LN
Second Line	:	APT 343
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73132-5511
Country	:	US
Telephone Number	:	918-408-7958
Fax Number	:

Provider Business Practice Location Address
First Line	:	7504 LYREWOOD LN
Second Line	:	APT 343
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73132-5511
Country	:	US
Telephone Number	:	918-408-7958
Fax Number	:

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

Provider Enumeration Date	:	12/13/2011
Last Update Date	:	12/13/2011

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