Provider Demographics
NPI:1902028616
Name:FULTON, NANETTE M (IP)
Entity type:Individual
Prefix:MRS
First Name:NANETTE
Middle Name:M
Last Name:FULTON
Suffix:
Gender:F
Credentials:IP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2028 TEMPLE RD
Mailing Address - Street 2:
Mailing Address - City:BUCYRUS
Mailing Address - State:OH
Mailing Address - Zip Code:44820-9784
Mailing Address - Country:US
Mailing Address - Phone:419-562-2158
Mailing Address - Fax:
Practice Address - Street 1:2028 TEMPLE RD
Practice Address - Street 2:
Practice Address - City:BUCYRUS
Practice Address - State:OH
Practice Address - Zip Code:44820-9784
Practice Address - Country:US
Practice Address - Phone:419-562-2158
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-03
Last Update Date:2020-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2097770OtherINDPENDENT PROVIDER #