Healthcare Provider Details

I. General information

NPI: 1336054311
Provider Name (Legal Business Name): MRS. NATALIE MARIE FULLER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/15/2026
Last Update Date: 08/15/2026
Certification Date: 08/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

205 W FRANCISCAN DR
CROWN POINT IN
46307-4802
US

IV. Provider business mailing address

5326 RUDD CT
CROWN POINT IN
46307-0146
US

V. Phone/Fax

Practice location:
  • Phone: 888-419-2576
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberBACB1618040
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: