MEDICARE: BRIA FULLERTON APRN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163W00000X	Registered Nurse	RN.515279	OH
2	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	APRN.CNP.0040489	OH

General Provider Information

NPI Number	:	1275382731
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRIA FULLERTON APRN

Provider Business Mailing Address
First Line	:	26250 EUCLID AVE STE 901
Second Line	:
City	:	EUCLID
State	:	OH
Zip	:	44132-3696
Country	:	US
Telephone Number	:	216-245-2823
Fax Number	:	334-362-9974

Provider Business Practice Location Address
First Line	:	26250 EUCLID AVE STE 901
Second Line	:
City	:	EUCLID
State	:	OH
Zip	:	44132-3696
Country	:	US
Telephone Number	:	216-245-2823
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/16/2024
Last Update Date	:	05/13/2026

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