Individual
KATIE MARIE FULK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MA, RDN, LD
Contact information
Practice address
12436 BRYIE RD, CHURUBUSCO, IN 46723-9225
(765) 744-8889
Mailing address
PO BOX 5600, FORT WAYNE, IN 46895-5600
(260) 266-6562
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
37002864A
IN
Other
Enumeration date
08/29/2023
Last updated
09/21/2023
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