Fuller, Mark A
Fuller, Mark A is an sole proprietor health care provider with primary practice located at 2215 W Willow Knolls Drive Apt 503A, Peoria IL 61614-1446. He recently has only one registered license in Transportation Services / Taxi, which is considered as his primary health care specialty. Fuller, Mark A can be contacted via phone (217) 330-0928.Contact Information
Primary practice address
2215 W Willow Knolls Drive Apt 503A
Peoria IL 61614-1446
Phone: (217) 330-0928
Fax:
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Transportation Services / Taxi | 344600000X |
Profile Details
| NPI number | 1417470147 |
|---|---|
| LBN Legal business name | Fuller, Mark A |
| Credentials | |
| Entity | Individual |
| Sole proprietor 1 | Yes |
| Enumeration date | Jul 25th, 2017 |
| Last updated | Jul 21st, 2022 - about 4 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1417470147 | NPPES |
| Illinois | MEDICAID | 82-2237856 |
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