Individual
LISA FULTON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
119 PRAETORIAN CT, WILMINGTON, OH 45177-9010
(937) 672-0581
Mailing address
119 PRAETORIAN CT, WILMINGTON, OH 45177-9010
(937) 672-0581
Taxonomy
Speciality
Code
Description
License number
State
343900000X
Non-emergency Medical Transport (VAN)
—
—
347C00000X
Private Vehicle
—
—
3747P1801X
Personal Care Attendant
Primary
—
—
376J00000X
Homemaker
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0225898
—
OH
Enumeration date
09/30/2020
Last updated
09/30/2020
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