MEDICARE: MEGAN FULKERSON

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	163W00000X	Registered Nurse	4704222878	MI

General Provider Information

NPI Number	:	1740664507
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MEGAN FULKERSON

Provider Business Mailing Address
First Line	:	191 PARSONS LN
Second Line	:
City	:	ROCHESTER HILLS
State	:	MI
Zip	:	48307-2847
Country	:	US
Telephone Number	:	248-656-3099
Fax Number	:

Provider Business Practice Location Address
First Line	:	191 PARSONS LN
Second Line	:
City	:	ROCHESTER HILLS
State	:	MI
Zip	:	48307-2847
Country	:	US
Telephone Number	:	248-656-3099
Fax Number	:

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

Provider Enumeration Date	:	07/11/2015
Last Update Date	:	07/11/2015

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