Individual
JARIAH FULSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
ATC
Contact information
Practice address
2300 S 1ST ST, CHAMPAIGN, IL 61820-7661
(000) 000-0000
Mailing address
406 E MICHIGAN AVE APT 1, URBANA, IL 61801-5061
(402) 926-1874
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
096004415
IL
2255A2300X
Athletic Trainer
—
NE
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2255A2300X
ATHLETIC TRAINER
—
Enumeration date
09/04/2014
Last updated
07/21/2022
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