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Individual
SHELLEY JEAN FULTZ
Active
Individual
SHELLEY JEAN FULTZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LPN
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
L3849
ND
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
054519
—
ND
Enumeration date
10/13/2006
Last updated
07/09/2007
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