Data from the NPPES registry. May not reflect recent changes — verify at nppes.cms.hhs.gov.
MARK A FULLER
Active Sole ProprietorMARK A FULLER is a Van Provider healthcare provider located in PEORIA, Illinois. NPI 1417470147 is currently active in the NPPES registry. Verify at CMS.
Van Provider · PEORIA, IL
Registration Details
- NPI Number
- 1417470147
- Provider Type
- Individual
- Gender
- Male
- NPI Issued
- Jul 25, 2017 (9.0510677807008 yrs)
- Last Updated
- Jul 21, 2022
- Sole Proprietor
- Yes
Practice Information
- Address
-
2215 W WILLOW KNOLLS DRIVEAPT 503APEORIA, IL, 616141446Browse IL providers · Browse ZIP 61614
- Phone
- 2173300928
- Primary Specialty
-
Van Provider
344600000X
Data sourced from the NPPES National Provider Identifier registry. This information is for informational purposes only and is not a substitute for verifying credentials with the appropriate licensing authority. For official verification, use the NPPES NPI Registry or the relevant state medical board.