Individual
RENAE FULKS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
13460 CAMBRIDGE ST APT 203, SOUTHGATE, MI 48195-1540
(734) 444-6831
Mailing address
13460 CAMBRIDGE ST APT 203, SOUTHGATE, MI 48195-1540
(734) 444-6831
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
4703111417
MI
Other
Enumeration date
05/08/2015
Last updated
05/08/2015
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