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JACQUELINE FULLER
NPI 1689049272
Licensed Practical Nurse in Southfield, MI

Active since December 08, 2015
23598 CIVIC CENTER DR, SOUTHFIELD, MI 48033(248) 469-9821 Get Directions Write a Review

NPPES record last updated: December 8, 2015. Verified against the NPPES registry weekly; last sync: August 09, 2026.

About Jacqueline Fuller NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

JACQUELINE FULLER (NPI 1689049272) is an individual licensed practical nurse in Southfield, Michigan, licensed in Michigan (4703112821) and active in the NPI registry since December 2015.

NPPES Registry Identity

NPI1689049272
Entity TypeIndividualFemale
Primary Taxonomy164W00000X
Provider Legal NameJACQUELINE FULLER
Location Address23598 CIVIC CENTER DRSouthfield, MI 48033-7134
Mailing Address23598 Civic Center DrSouthfield, MI 48033-7134 · (248) 469-9821
Phone(248) 469-9821
Sole ProprietorNo
Enumeration DateDecember 8, 2015
✔ NPI 1689049272 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyLicensed Practical NurseNursing Service Providers
Taxonomy Code164W00000X
License✔ Licensed in MI · 4703112821
Definition
A licensed practical nurse with post-high school vocational training and practical experience in the provision of nursing care at a level less than that required for certification as a Registered Nurse. Requirements for education, experience, licensure, and job responsibilities vary among the states.
23598 CIVIC CENTER DR, Southfield, MI 48033
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Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Jacqueline Fuller's NPI number?

The NPI number for Jacqueline Fuller is 1689049272. It was assigned to this individual provider in the NPPES registry on December 8, 2015.

Where is Jacqueline Fuller located?

Jacqueline Fuller practices at 23598 Civic Center Dr, Southfield, MI 48033. The listed phone number is (248) 469-9821.

What is Jacqueline Fuller's specialty?

The primary specialty registered for this NPI is Licensed Practical Nurse with taxonomy code 164W00000X.

When was this NPI record last updated?

The NPPES record for Jacqueline Fuller was last updated on December 8, 2015. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 10 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.