Shawn M Fuller, LPN

Primary specialty

Licensed Practical NurseTaxonomy code 164W00000X

License

LPN296982 Issued in PA

Practice address

508 S Church St Ste 201
Mount Pleasant, PA 15666-1702

Phone

(724) 365-4020

Fax

(724) 547-3041

NPI assigned

Nov 13, 2018

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

Practice roles

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.

• Gateway Rehabilitation Center

  • Substance Abuse Rehabilitation Facility
  • Mt Pleasant, PA
  • NPI 1124485149
  NPD (past)

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

{
    "created_epoch": "1542067200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1542067200000",
    "number": "1861960460",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "311 ROUSER RD",
            "city": "MOON TOWNSHIP",
            "state": "PA",
            "postal_code": "151086801",
            "telephone_number": "412-604-8900",
            "fax_number": "412-299-8755"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "508 S CHURCH ST STE 201",
            "city": "MOUNT PLEASANT",
            "state": "PA",
            "postal_code": "156661702",
            "telephone_number": "724-365-4020",
            "fax_number": "724-547-3041"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FULLER",
        "first_name": "SHAWN",
        "middle_name": "M",
        "name_prefix": "Mr.",
        "credential": "LPN",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2018-11-13",
        "last_updated": "2018-11-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "164W00000X",
            "taxonomy_group": "",
            "desc": "Licensed Practical Nurse",
            "state": "PA",
            "license": "LPN296982",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Tyler Fox
• Sherri Lynn Fredlock, S.T.
• Frick Hospital
• Frick Hospital
• Frick Hospital
• Brian Joseph Garcher, PT
• Gateway Rehabilitation Center
• Amy Geary
• Jerome W Gera, MD
• Habiba Health Services PC

• All providers in Mount Pleasant, PA
• Licensed Practical Nurse in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 13, 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.