Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Justin Wayne Fuller

Individual provider Certified Registered Nurse Anesthetist · NPI 1962176917

Justin Wayne Fuller is a Certified Registered Nurse Anesthetist (CRNA) in Mesa, Arizona. Qualified in 2021, 5 years ago. Practices with Banner Hospital Based Physicians Arizona LLC, a 641-clinician group and accepts Medicare assignment. Licensed in Arizona.

Years since qualifying
5
Licensed in
AZ
In the registry since
2021
Specialties on file
2
Claim this listing Report a problem Suggest an edit

Practice location Address checks out

1400 S Dobson Rd
Mesa, AZ 85202-4707
Phone: (972) 761-5508
Show map & directions

Directions in Google Maps · Apple Maps · OpenStreetMap

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Certified Registered Nurse Anesthetist (primary) Taxonomy 367500000X · Licence 264564 (AZ)
Certified Registered Nurse Anesthetist Taxonomy 367500000X · Licence RN185391 (AZ)

Record details

NPI number1962176917
Entity typeIndividual (Type 1)
GenderMale
Sole proprietorNo
NPI enumeratedAugust 3, 2021
Last updated in NPPESOctober 26, 2021
Certification dateOctober 26, 2021

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyCERTIFIED REGISTERED NURSE ANESTHETIST (CRNA)
Medical schoolOTHER
Graduated 2021 (5 years in practice)
Group practice Banner Hospital Based Physicians Arizona Llc — 641 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount

Other providers in Mesa