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NPI Code Detail

MEDICARE: NONA P FULK M.D.

MEDICARE: NONA P FULK M.D.
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
1207V00000XObstetrics & Gynecology Physician036096101IL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1619974227
Entity Type Code : Individual
Provider Name (Legal Business Name) : NONA P FULK M.D.
Provider Business Mailing Address
First Line : 1300 FRANKLIN AVE STE 330
Second Line :
City : NORMAL
State : IL
Zip : 61761-4204
Country : US
Telephone Number : 309-808-0940
Fax Number : 309-808-0799
Provider Business Practice Location Address
First Line : 800 E LOCUST ST
Second Line :
City : OLNEY
State : IL
Zip : 62450-2553
Country : US
Telephone Number : 618-392-9520
Fax Number : 618-395-5117
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/29/2005
Last Update Date : 03/14/2025

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Directions to “ NONA P FULK M.D.” Practice Location

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