MR. BRIAN D FULLER (NPI# 1063432359) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1063432359 |
| Entity Type | Individual |
| Full Name | MR. BRIAN D FULLER |
| Credential | CRNA |
| Practice Address |
111 W State St Boise ID 83702-6127 |
| Practice Telephone | 2083360895 |
| Practice Fax Number | 2083381796 |
| Mailing Telephone | 2083360895 |
| Mailing Fax Number | 2083381796 |
| Enumeration Date | 2006-07-20 |
| Last Update Date | 2007-07-09 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 174400000X | Specialist | RNA658 | ID | Other Service Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| ID | 807489400 | 05 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1760674725 | Brian Scott Fuller | Dentist | 1920 S 1st St, 1509, Minneapolis, MN 55454-1055 | 2007-08-14 |
| 1316035280 | Brian Christopher Fuller | Pediatrics | 2401 Village Professional Drive, Opelika, AL 36801-4702 | 2006-10-10 |
| 1073556544 | Brian Jay Fuller | Chiropractor | 211 N Clinton St, Suite 2s, Chicago, IL 60661-1282 | 2006-06-13 |
| 1972562601 | Brian George Fuller | Physical Therapist | 15 Porters Glen Pl, Durham, NC 27713-9164 | 2006-03-21 |
| 1730174160 | Brian J Fuller | Physical Therapist | 4453 State Route 159, Chillicothe, OH 45601-8620 | 2005-09-12 |
| 1427540178 | Brian Fuller | Pediatrics | 1200 S Cedar Crest Blvd, Allentown, PA 18103-6202 | 2018-05-30 |
| 1184915365 | Brian Robert Fuller | Pharmacist | 105 Mall Blvd, Monroeville, PA 15146-2230 | 2011-04-22 |
| 1033409438 | Brian Edward Fuller | Psychiatry & Neurology | 6107 Pinewood Rd, Nunnelly, TN 37137-2523 | 2011-04-19 |
| 1780973982 | Brian J Fuller | Family Medicine | 6909 Good Samaritan Dr, Suite A, Cincinnati, OH 45247-5208 | 2011-03-29 |
| 1336473032 | Brian K Fuller | Case Manager/Care Coordinator | 3211 Jefferson St, San Diego, CA 92110-4424 | 2009-09-28 |
| Street Address |
111 W STATE ST |
| City | BOISE |
| State | ID |
| Zip Code | 83702-6127 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1528019460 | Robert M Centeno | Anesthesiology | 111 W State St, Boise, ID 83702-6127 | 2006-05-15 |
| 1225453855 | Kristi Michel Pardue | Speech-Language Pathologist | 111 W State St, Boise, ID 83702-6127 | 2014-02-18 |
| 1013158807 | Jordan B Wolff | Nurse Anesthetist, Certified Registered | 111 W State St, Boise, ID 83702-6127 | 2009-03-09 |
| 1750521548 | Kurt Brandon Hiatt | Nurse Anesthetist, Certified Registered | 111 W State St, Boise, ID 83702-6127 | 2009-03-06 |
| 1265679856 | Mark L Edlefsen | Nurse Anesthetist, Certified Registered | 111 W State St, Boise, ID 83702-6127 | 2009-01-19 |
| 1689824633 | Charles B Gladwell | Nurse Anesthetist, Certified Registered | 111 W State St, Boise, ID 83702-6127 | 2008-09-26 |
| 1902060981 | Kristy Rowberry | Nurse Anesthetist, Certified Registered | 111 W State St, Boise, ID 83702-6127 | 2008-07-18 |
| 1801069190 | David L Merrill | Nurse Anesthetist, Certified Registered | 111 W State St, Boise, ID 83702-6127 | 2008-04-08 |
| 1689851487 | John Pozar | Nurse Anesthetist, Certified Registered | 111 W State St, Boise, ID 83702-6127 | 2008-01-24 |
| 1053500645 | Melanie R Ahrens | Nurse Anesthetist, Certified Registered | 111 W State St, Boise, ID 83702-6127 | 2007-10-18 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1790321966 | Inland Northwest Neuromonitoring Pllc | Psychiatry & Neurology | 950 Bannock Street, Suite 1100, Boise, ID 83702 | 2019-11-22 |
| 1508359084 | Emily Cook | Dietitian, Registered | St. Luke's Rehab Hospital, 600 N Robbins Road, Bosie, ID 83702 | 2018-06-11 |
| 1265925887 | Marla Braendle | Dietitian, Registered | St. Luke's Rehabilitation Hospital, 600 N. Robbins Road, Boise, ID 83702 | 2018-06-08 |
| 1114419678 | Sidrah Khan Psychotherapy PC | Social Worker | 242 N 8th St, Suite 200, Boise, ID 83702 | 2018-05-31 |
| 1508386707 | Emp Idaho Nampa, LLC | General Acute Care Hospital | 350 E Myrtle Street, Suite 100, Boise, ID 83702 | 2017-06-20 |
| 1194264077 | Karen Mangum | Dietitian, Registered | 115 N. Main Street, Suite #203, Boise, ID 83702 | 2017-02-13 |
| 1750828422 | Stephen Pyper | Massage Therapist | 14089 Main St #100, Boise, ID 83702 | 2017-01-19 |
| 1427504398 | The Young Mens Christian Association of Boise City Idaho | Health Educator | 419 N 11th St, Boise, ID 83702 | 2016-08-30 |
| 1942756838 | Brent Hiroshi Sasaki | Pharmacist | 500 West Fort Street (119), Boise, ID 83702 | 2016-08-30 |
| 1578912051 | Marnae Walker | Counselor | 509 S. 14th St, Suite 2, Boise, ID 83702 | 2016-06-06 |
| Find all providers in zip 83702 | ||||
| Taxonomy Code | 174400000X |
| Grouping | Other Service Providers |
| Classification | Specialist |
| An individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree. |
| Notes: Source: Expanded from Webster’s II New Riverside University Dictionary, Boston: Riverside Publishing Company, 1974. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1851855803 | Lauren Rybarczyk | Specialist | 11498 W Carmichael Dr, Boise, ID 83709-7382 | 2019-01-24 |
| 1851834311 | Tegan Shuman | Specialist | 7307 W San Fernando Dr, Boise, ID 83704-5953 | 2016-11-30 |
| 1952768145 | Katie Garcin | Specialist | 1407 E Boston Dr, Boise, ID 83706 | 2016-01-20 |
| 1093119042 | Robert Porter II | Specialist | 1346 E Candleridge Dr, Boise, ID 83712-6504 | 2014-10-20 |
| 1760885073 | Kelcee Keyes | Specialist | 1705 N Cole Rd, Boise, ID 83704-7304 | 2014-09-30 |
| 1386053213 | Keita Shimada | Specialist | 1910 University Dr # Ms 1020, Boise, ID 83725-0001 | 2014-08-05 |
| 1316373186 | Ralph V Nishitani | Specialist | 9317 W Pandion Ct, Boise, ID 83714-6715 | 2013-09-24 |
| 1548608094 | James Doyce Strong Jr. | Specialist | 3675 S Pimmit Ave, Boise, ID 83706-6416 | 2013-06-06 |
| 1649409269 | Iris Ginron Baker | Specialist | 3555 N Cole Rd, 105, Boise, ID 83704-0733 | 2009-07-02 |
| 1356589931 | Jay T. Ballhagen | Specialist | 10500 W Waterway Ct, Boise, ID 83714-3616 | 2009-02-04 |
| Find all providers in BOISE | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.