Individual
ELIZABETH ANN FULFORD
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
2450 S TELSHOR BLVD, LAS CRUCES, NM 88011-5069
(575) 522-8641
Mailing address
4565 MESA CORTA DR, LAS CRUCES, NM 88011-6040
(586) 876-1405
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
68003
NM
367500000X
Certified Registered Nurse Anesthetist
Primary
68003
NM
390200000X
Student in an Organized Health Care Education/Training Program
041470039
IL
Other
Enumeration date
09/07/2022
Last updated
01/26/2023
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