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General NPI Number Information
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NPI Number | 1699610238
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Entity Type | Individual
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Provider Name | MIKO FULMORE RN
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Gender | Male
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Dates
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Enumeration Date | 04/21/2026
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Last Update Date | 04/21/2026
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Provider Practice Location Address
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Address Line | 145 E CHEVES ST
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City | FLORENCE
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State | SC
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Zip | 29506-2526
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Country | US
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Telephone | 843-617-9556
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 6694
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City | FLORENCE
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State | SC
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Zip | 29502-6694
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Country | US
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Telephone | 843-344-2293
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Fax |
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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 | 163WI0600X
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Taxonomy Name | Infection Control Registered Nurse
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License Number | 210923
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License Number State | SC
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