Provider Demographics
NPI:1114802253
Name:FULLER, HEATHER J (RDN)
Entity type:Individual
Prefix:
First Name:HEATHER
Middle Name:J
Last Name:FULLER
Suffix:
Gender:F
Credentials:RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:694 LINCOLN AVE APT 3
Mailing Address - Street 2:
Mailing Address - City:CLAWSON
Mailing Address - State:MI
Mailing Address - Zip Code:48017-2505
Mailing Address - Country:US
Mailing Address - Phone:517-455-8127
Mailing Address - Fax:517-455-8127
Practice Address - Street 1:694 LINCOLN AVE APT 3
Practice Address - Street 2:
Practice Address - City:CLAWSON
Practice Address - State:MI
Practice Address - Zip Code:48017-2505
Practice Address - Country:US
Practice Address - Phone:517-455-8127
Practice Address - Fax:517-455-8127
Is Sole Proprietor?:No
Enumeration Date:2025-08-07
Last Update Date:2025-08-07
Deactivation Date:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered