Mimi O Fuller, CNA

Primary specialty

Certified Registered Nurse AnesthetistTaxonomy code 367500000X

License

SCAPN987 Issued in SC

Practice address

735 E Main Street
Spartanburg, SC 29302-1281

Phone

(864) 542-1308

NPI assigned

Aug 25, 2006

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Spartanburg Surgery Center, LLC

  • Ambulatory Surgical Clinic/Center
  • Spartanburg, SC
  • NPI 1811076623
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1156464000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1193270400000",
    "number": "1326155128",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "735 E MAIN STREET",
            "city": "SPARTANBURG",
            "state": "SC",
            "postal_code": "293021281",
            "telephone_number": "864-542-1308"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "735 E MAIN STREET",
            "city": "SPARTANBURG",
            "state": "SC",
            "postal_code": "293021281",
            "telephone_number": "864-542-1308"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FULLER",
        "first_name": "MIMI",
        "middle_name": "O",
        "credential": "CNA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-08-25",
        "last_updated": "2007-10-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "SC",
            "license": "SCAPN987",
            "primary": true
        },
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "SC",
            "license": "AANA22356",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "AN0665",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Brooke Webster Fuentes, PA-C
• Brandi Fugate
• Adam Joseph Fulcher, DO
• Harold Jones Fuller Jr., M.D.
• Jason Matthew Fuller, MD
• Eric S Fulmer, MD
• James Sidney Fulmer Sr., M.D.
• Sara Elizabeth Fulton, M.S., CCC-SLP
• Kristyn Michele Funderburke, PHARMD
• Dorotea M Gabel, M.D.

• Certified Registered Nurse Anesthetist in Spartanburg, SC
• Providers in Spartanburg, SC by specialty
• Certified Registered Nurse Anesthetist in South Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 25, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.