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Individual
MRS. AMANDA ANN FULWIDER
Active
Individual
MRS. AMANDA ANN FULWIDER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MA, AT, ATC
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
2000030605
—
2255A2300X
Athletic Trainer
Primary
AT006116
OH
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
AT006116
ATHLETIC TRAINER
OH
Enumeration date
09/01/2015
Last updated
03/29/2022
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