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General NPI Number Information
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NPI Number | 1821519943
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Entity Type | Individual
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Provider Name | JUDITH ANN FULTON FNP
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Gender | Female
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Dates
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Enumeration Date | 06/28/2017
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Last Update Date | 02/14/2022
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Provider Practice Location Address
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Address Line | 130 WAYNE FRYE DR
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City | MANCHESTER
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State | OH
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Zip | 45144-9314
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Country | US
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Telephone | 937-549-1270
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Fax | 937-549-1286
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Provider Business Mailing Address
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Address Line | 14575 STATE ROUTE 41
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City | WEST UNION
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State | OH
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Zip | 45693-9744
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Country | US
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Telephone | 937-544-2269
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | APRN.CNP.020752
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License Number State | OH
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