Individual
VALERIE FULTON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
2457 PLAZA DR, BENTON HARBOR, MI 49022
(269) 934-0221
Mailing address
2457 PLAZA DR, BENTON HARBOR, MI 49022-2229
Taxonomy
Speciality
Code
Description
License number
State
372500000X
Chore Provider
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
81-4199186
—
MI
Enumeration date
09/20/2017
Last updated
09/20/2017
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