Ebony Dawn Mary Fuller, RBT

Primary specialty

Behavior TechnicianTaxonomy code 106S00000X

License

RBT-16-24833 Issued in HI

Practice address

41-611 Inoaole St
Waimanalo, HI 96795-1211

Phone

(808) 892-4059

NPI assigned

Dec 16, 2017

Sex

Female

Sole proprietor

No

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

• Mau Loa Learning

  • Behavior Technician
  • Waimanalo, HI
  • NPI 1962974998
  NPD (past)

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Mar 17, 2018.

{
    "created_epoch": "1513382400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1521244800000",
    "number": "1841706629",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "55-337 KAMEHAMEHA HWY",
            "city": "LAIE",
            "state": "HI",
            "postal_code": "967621136",
            "telephone_number": "808-450-5563"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "41-611 INOAOLE ST",
            "city": "WAIMANALO",
            "state": "HI",
            "postal_code": "967951211",
            "telephone_number": "808-892-4059"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "55-337 Kamehameha Hwy",
            "address_purpose": "LOCATION",
            "city": "Laie",
            "state": "HI",
            "postal_code": "967621136",
            "country_code": "US",
            "telephone_number": "808-450-5563",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "FULLER",
        "first_name": "EBONY",
        "middle_name": "DAWN MARY",
        "credential": "RBT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-12-16",
        "last_updated": "2018-03-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "106S00000X",
            "taxonomy_group": "",
            "desc": "Behavior Technician",
            "state": "HI",
            "license": "RBT-16-24833",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kaipo Kaleokuikealoaloha Dudoit
• Lauren C Evans, RN
• Bailey Jane Ferguson
• Katharine Finesilver
• Desmond Foo, M.D.
• Gabrielle Garcia
• Brenda Gartner
• Christina Gasbarro, BCBA, LBA
• Michael Alexander Gashwytewa
• Maggie Rose Gaylor

• All providers in Waimanalo, HI
• Behavior Technician in Hawaii

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 17, 2018; 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.