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NPI Code Detail

MEDICARE: MRS. MIRIAM C. FULTON R.N., NP

MEDICARE: MRS. MIRIAM C. FULTON R.N., NP
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363LA2200XAdult Health Nurse PractitionerRN247519CA

General Provider Information

NPI Number : 1124094685
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. MIRIAM C. FULTON R.N., NP
Provider Business Mailing Address
First Line : 2030 AVENIDA HACIENDA
Second Line :
City : CHINO HILLS
State : CA
Zip : 91709-4700
Country : US
Telephone Number : 909-393-7913
Fax Number :
Provider Business Practice Location Address
First Line : 1798 N GAREY AVE
Second Line :
City : POMONA
State : CA
Zip : 91767-2918
Country : US
Telephone Number : 909-865-9850
Fax Number : 909-623-6354
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/24/2006
Last Update Date : 07/08/2007

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