MEDICARE: MRS. DENISE SUZANNE FULMER RN

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	163WH0200X	Home Health Registered Nurse	289933	OH

Other Identifiers

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

General Provider Information

NPI Number	:	1821213661
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. DENISE SUZANNE FULMER RN

Provider Business Mailing Address
First Line	:	1726 MARILYN LANE
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45231-5223
Country	:	US
Telephone Number	:	513-521-8955
Fax Number	:

Provider Business Practice Location Address
First Line	:	1726 MARILYN AVE
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45231-5223
Country	:	US
Telephone Number	:	513-207-3603
Fax Number	:

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

Provider Enumeration Date	:	04/16/2007
Last Update Date	:	07/09/2007

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