Stanley B Fuller Sr., L.P.N.

Primary specialty

Licensed Practical NurseTaxonomy code 164W00000X

License

PN.102037 Issued in OH

Practice address

117 N Wayne St
117 N Wayne St
Fremont, OH 43420-2431

Phone

(419) 307-2984

NPI assigned

Apr 23, 2008

Last updated

Apr 23, 2008By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other names 1

• Mr. Stanley B Fuller Sr. Professional name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not 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.

• Stanley Fuller

  • Adult Care Home Facility
  • Fremont, OH
  • NPI 1073795423
  NPD (past) Authorized official

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

{
    "created_epoch": "1208908800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1208908800000",
    "number": "1639344344",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "117 N WAYNE ST",
            "address_2": "117 N WAYNE ST",
            "city": "FREMONT",
            "state": "OH",
            "postal_code": "434202431",
            "telephone_number": "419-307-2984"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "117 N WAYNE ST",
            "address_2": "117 N WAYNE ST",
            "city": "FREMONT",
            "state": "OH",
            "postal_code": "434202431",
            "telephone_number": "419-307-2984"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FULLER",
        "first_name": "STANLEY",
        "middle_name": "B",
        "name_prefix": "Mr.",
        "name_suffix": "Sr.",
        "credential": "L.P.N.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2008-04-23",
        "last_updated": "2008-04-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "164W00000X",
            "taxonomy_group": "",
            "desc": "Licensed Practical Nurse",
            "state": "OH",
            "license": "PN.102037",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "STANLEY",
            "last_name": "FULLER",
            "middle_name": "B",
            "prefix": "MR.",
            "suffix": "SR.",
            "credential": "L.P.N.",
            "code": "2",
            "type": "Professional Name"
        }
    ]
}

• Fremont Family Medicine, Inc.
• Fremont Health and Wellness Center
• Fremont Physicians Association
• Fremont Physicians LLC
• Fremont Walkin Medical Center, Inc
• Tasneem Gaballah
• Elizabeth A. Gabel, NP-C
• Julia Galbraith, LCDC-III
• Tally William Gallogly, LPCC, LICDC, SAP,CEA
• Kelsey Galloway

• Licensed Practical Nurse in Fremont, OH
• Providers in Fremont, OH by specialty
• Licensed Practical Nurse in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 23, 2008; 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.