Provider Demographics
NPI:1033588199
Name:FULLER, SHERRY (FNP-C)
Entity type:Individual
Prefix:
First Name:SHERRY
Middle Name:
Last Name:FULLER
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3333 REGIS BLVD # G8
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80221-1154
Mailing Address - Country:US
Mailing Address - Phone:303-964-6030
Mailing Address - Fax:303-964-5325
Practice Address - Street 1:3333 REGIS BLVD # G8
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80221-1154
Practice Address - Country:US
Practice Address - Phone:303-964-6030
Practice Address - Fax:303-964-5325
Is Sole Proprietor?:No
Enumeration Date:2015-09-18
Last Update Date:2015-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CORN0162400163W00000X
COAPN0005724-NP163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse