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Individual

MRS. SHANNON FULTZ

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
NP

Contact information

Practice address
593 EDDY ST, PROVIDENCE, RI 02903-4923
(401) 793-9166
(401) 444-2788
Mailing address
15 LA SALLE SQ, PROVIDENCE, RI 02903-1814
(401) 444-6779
(401) 444-6912

Taxonomy

Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
APRN02454
RI
363LA2100X
Acute Care Nurse Practitioner
APRN02454
RI

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
APRN02454
STATE
RI
Enumeration date
02/19/2021
Last updated
07/29/2026
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