NPI 1417470147
Mark a Fuller
Practice location
- Address
- 2215 W Willow Knolls Drive APT 503a, Peoria, IL 61614-1446
- Phone
- (217) 330-0928
- Mailing address
- 2215 W Willow Knolls Dr APT 503a, Peoria, IL 61614-1446
Registered specialties
Taxi
Primary
Registry record
- NPI
- 1417470147
- Entity type
- Individual
- Sex (as registered)
- Male
- NPI issued
- 25 Jul 2017
- Record last updated
- 21 Jul 2022
Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.