Ebay L Fuller

Primary specialty

DriverTaxonomy code 172A00000X

License

RU776904 Issued in OH

Practice address

4403 E 143Rd St
Cleveland, OH 44128-2311

Phone

(216) 894-1548

NPI assigned

Apr 11, 2024

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1712793600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1712793600000",
    "number": "1487408027",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "16705 MAPLE HEIGHTS BLVD",
            "city": "MAPLE HEIGHTS",
            "state": "OH",
            "postal_code": "441372642",
            "telephone_number": "216-894-1548"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4403 E 143RD ST",
            "city": "CLEVELAND",
            "state": "OH",
            "postal_code": "441282311",
            "telephone_number": "216-894-1548"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FULLER",
        "first_name": "EBAY",
        "middle_name": "L",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2024-04-11",
        "last_updated": "2024-04-11",
        "certification_date": "2024-04-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "172A00000X",
            "taxonomy_group": "",
            "desc": "Driver",
            "state": "OH",
            "license": "RU776904",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Tonya L Fulk, CNP
• Elizabeth Fulkroad, LISW
• Full Court Press LLC
• Rachel Fullen
• Carrie E Fuller, CNP
• Keith A Fuller, MD
• Kimberly A Fuller, LISW-S
• Mi'Kia Ruth Elizabeth Fuller I, STNA
• Quinetta S Fuller
• Sandrell Fuller, RN

• Driver in Cleveland, OH
• Providers in Cleveland, OH by specialty
• Driver in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 11, 2024; 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.