Active NPI
Lakila Tierra Fuller
- Other Technician
- Inkster, MI
National Provider Identifier
1679920748
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Other Technician
- License
- F460488793741
- Practice address
- 26431 Princeton St
Inkster, MI 48141-2444 - Phone
- (313) 207-8034
- NPI assigned
- May 19, 2016
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Other Technician | 247200000X | F460488793741 | MI | Primary |
Addresses
Primary practice location
26431 Princeton St
Inkster, MI 48141-2444
Mailing address
26431 Princeton St
Inkster, MI 48141-2444
Phone (313) 207-8034
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| F460488793741 | MI | MD | Other Technician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1463616000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1463616000000",
"number": "1679920748",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "26431 PRINCETON ST",
"city": "INKSTER",
"state": "MI",
"postal_code": "481412444",
"telephone_number": "313-207-8034"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "26431 PRINCETON ST",
"city": "INKSTER",
"state": "MI",
"postal_code": "481412444",
"telephone_number": "313-207-8034"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FULLER",
"first_name": "LAKILA",
"middle_name": "TIERRA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2016-05-19",
"last_updated": "2016-05-19",
"status": "A"
},
"taxonomies": [
{
"code": "247200000X",
"taxonomy_group": "",
"desc": "Technician, Other",
"state": "MI",
"license": "F460488793741",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Inkster, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 19, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.