Provider Demographics
NPI:1679058622
Name:FULINE, KATIE
Entity type:Individual
Prefix:
First Name:KATIE
Middle Name:
Last Name:FULINE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:533 OAKRIDGE DR
Mailing Address - Street 2:
Mailing Address - City:BOARDMAN
Mailing Address - State:OH
Mailing Address - Zip Code:44512-3147
Mailing Address - Country:US
Mailing Address - Phone:330-519-9235
Mailing Address - Fax:
Practice Address - Street 1:533 OAKRIDGE DR
Practice Address - Street 2:
Practice Address - City:BOARDMAN
Practice Address - State:OH
Practice Address - Zip Code:44512-3147
Practice Address - Country:US
Practice Address - Phone:330-519-9235
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-26
Last Update Date:2025-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADN006685133V00000X
OHLD.7443133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered