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FULLER, MARY ANN       
This verification service provides current data extracted by the Oklahoma State Board of Medical Licensure and Supervision (OSBMLS) from its own database. The data enclosed in the green box below is provided by and controlled entirely by the OSBMLS and therefore constitutes a primary source verification of licensure status as authentic as a direct inquiry to the OSBMLS. NPI# and hospital privileges (if any) are provided by the licensee and not verified.
Practice Address: DAVITA GRAPEVINE DIALYSIS
1600 W. NORTHWEST HWY. STE. 100
GRAPEVINE TX 76051

Address last updated on 10/2/2008
Phone #: (817) 424-4091
Fax #: (817) 329-2916
County: NOT OKLAHOMA
License: 427
Dated: 10/1/1985
Expires: 10/31/2008
License Type: Licensed Dietitian
Specialty:
Status: Inactive
Status Class: Expired License
Restricted to:
CME Year:
Pending and/or Past Disciplinary Actions: No Disciplinary Action Taken.
All information below is entered by the licensee but not verified by the Oklahoma Medical Board.
Locations: Hours: Languages:
DAVITA GRAPEVINE DIALYSIS
1600 W. NORTHWEST HWY. STE. 100
GRAPEVINE TX 76051

Phone #: (817) 424-4091
Fax #: (817) 329-2916

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