Individual
BRETT A FULKS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
611 W. PARK ST., URBANA, IL 61801
(217) 383-3311
Mailing address
611 W. PARK ST., FAPC, URBANA, IL 61801
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
209019137
IL
Other
Enumeration date
10/09/2019
Last updated
10/11/2019
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