Provider Demographics
NPI:1184804478
Name:FULLER, ROSMARIE ANN (RNC,MSN,APRN,IBCLC)
Entity type:Individual
Prefix:MRS
First Name:ROSMARIE
Middle Name:ANN
Last Name:FULLER
Suffix:
Gender:F
Credentials:RNC,MSN,APRN,IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:83 HERRICK ST
Mailing Address - Street 2:
Mailing Address - City:BEVERLY
Mailing Address - State:MA
Mailing Address - Zip Code:01915-2757
Mailing Address - Country:US
Mailing Address - Phone:978-927-4980
Mailing Address - Fax:978-922-9115
Practice Address - Street 1:83 HERRICK ST
Practice Address - Street 2:
Practice Address - City:BEVERLY
Practice Address - State:MA
Practice Address - Zip Code:01915-2757
Practice Address - Country:US
Practice Address - Phone:978-927-4980
Practice Address - Fax:978-922-9115
Is Sole Proprietor?:No
Enumeration Date:2007-11-05
Last Update Date:2007-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA188948363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics