Fuller, Jalisa
Fuller, Jalisa is an individual health care provider with primary practice located at 1621 Williamsburg Dr , Bossier City LA 71112-3165. She recently has only one registered license in Other Service Providers / Driver, which is considered as her primary health care specialty. Fuller, Jalisa can be contacted via phone (318) 730-2368.Contact Information
Primary practice address
1621 Williamsburg Dr
Bossier City LA 71112-3165
Phone: (318) 730-2368
Fax:
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Other Service Providers / Driver | 172A00000X | 009494849 | Louisiana |
Profile Details
| NPI number | 1982270088 |
|---|---|
| LBN Legal business name | Fuller, Jalisa |
| Credentials | |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | May 28th, 2021 |
| Last updated | May 28th, 2021 - 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 | 1982270088 | NPPES |
| Louisiana | MEDICAID | 843382246 |
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