Provider Demographics
NPI:1386412138
Name:FULLER, CRESETA E (RN)
Entity type:Individual
Prefix:
First Name:CRESETA
Middle Name:E
Last Name:FULLER
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:560 VILLAGE BLVD STE 260
Mailing Address - Street 2:
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33409-1963
Mailing Address - Country:US
Mailing Address - Phone:877-687-7399
Mailing Address - Fax:
Practice Address - Street 1:ELBOWOODS MEMORIAL HEALTH CENTR
Practice Address - Street 2:1058 COLLEGE DRIVE
Practice Address - City:NEW TOWN
Practice Address - State:ND
Practice Address - Zip Code:58763
Practice Address - Country:US
Practice Address - Phone:701-627-7904
Practice Address - Fax:701-627-2809
Is Sole Proprietor?:Yes
Enumeration Date:2023-12-12
Last Update Date:2023-12-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLRN9541126163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse