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General NPI Number Information
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NPI Number | 1164337358
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Entity Type | Individual
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Provider Name | MELANIE SUE FULFORD
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Gender | Female
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Dates
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Enumeration Date | 08/14/2026
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Last Update Date | 08/14/2026
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Provider Practice Location Address
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Address Line | 300 HIGHWAY 361, BUILDING 2516 MEDICAL
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City | CRANE
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State | IN
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Zip | 47522
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Country | US
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Telephone | 812-854-1220
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Fax | 812-854-1339
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Provider Business Mailing Address
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Address Line | 300 HIGHWAY 361, BUILDING 2516 MEDICAL
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City | CRANE
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State | IN
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Zip | 47522
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Country | US
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Telephone | 812-854-1220
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Fax | 812-854-1339
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 163WX0106X
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Taxonomy Name | Occupational Health Registered Nurse
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License Number | 28162777C
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License Number State | IN
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