MEDICARE: MS. PATRICIA FULLIN ACUPUNCTURISTS

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
1	171100000X	Acupuncturist	633-55	WI

General Provider Information

NPI Number	:	1316392178
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. PATRICIA FULLIN ACUPUNCTURISTS

Provider Business Mailing Address
First Line	:	4211 GREEN BAY RD
Second Line	:
City	:	KENOSHA
State	:	WI
Zip	:	53144-4521
Country	:	US
Telephone Number	:	262-925-9018
Fax Number	:

Provider Business Practice Location Address
First Line	:	4211 GREEN BAY RD
Second Line	:
City	:	KENOSHA
State	:	WI
Zip	:	53144-4521
Country	:	US
Telephone Number	:	262-925-9018
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/29/2016
Last Update Date	:	04/29/2016

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