Individual
MRS. SHANNON FULTZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
APRN
Contact information
Practice address
3 MYRTLE AVE, RIVERSIDE, RI 02915-4733
(603) 765-1431
Mailing address
3 MYRTLE AVE, RIVERSIDE, RI 02915-4733
Taxonomy
Speciality
Code
Description
License number
State
363LA2100X
Acute Care Nurse Practitioner
Primary
APRN02454
RI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
APRN02454
STATE
RI
Enumeration date
02/19/2021
Last updated
02/19/2021
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