Healthcare Provider Details

I. General information

NPI: 1821213661
Provider Name (Legal Business Name): DENISE SUZANNE FULMER RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/16/2007
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1726 MARILYN AVE
CINCINNATI OH
45231-5223
US

IV. Provider business mailing address

1726 MARILYN LANE
CINCINNATI OH
45231-5223
US

V. Phone/Fax

Practice location:
  • Phone: 513-207-3603
  • Fax:
Mailing address:
  • Phone: 513-521-8955
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License Number289933
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: