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NPI Code Detail

MEDICARE: EDWARD K FULLER CRNA

MEDICARE: EDWARD K FULLER CRNA
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
1367500000XCertified Registered Nurse Anesthetist848145NV

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1851321301
Entity Type Code : Individual
Provider Name (Legal Business Name) : EDWARD K FULLER CRNA
Provider Business Mailing Address
First Line : PO BOX 840857
Second Line :
City : DALLAS
State : TX
Zip : 75284-0857
Country : US
Telephone Number : 725-204-4632
Fax Number : 702-805-0307
Provider Business Practice Location Address
First Line : 7160 RAFAEL RIVERA WAY STE 210
Second Line :
City : LAS VEGAS
State : NV
Zip : 89113-5395
Country : US
Telephone Number : 702-878-0070
Fax Number : 702-805-0307
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/03/2006
Last Update Date : 10/20/2023

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