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General NPI Number Information
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NPI Number | 1942357306
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Entity Type | Individual
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Provider Name | PAMELA ANGEL FULTON NP
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Gender | Female
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Dates
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Enumeration Date | 01/05/2007
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Last Update Date | 02/28/2017
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Provider Practice Location Address
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Address Line | 1308 QUINCY ST NE
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City | ALBUQUERQUE
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State | NM
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Zip | 87110-5021
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Country | US
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Telephone | 505-453-4727
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Fax |
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Provider Business Mailing Address
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Address Line | 1308 QUINCY ST NE
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City | ALBUQUERQUE
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State | NM
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Zip | 87110-5021
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Country | US
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Telephone | 505-453-4727
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Fax | 877-860-2279
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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 | CNP 00616
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License Number State | NM
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Taxonomy #2
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | CNP00616
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License Number State | NM
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