Individual
EMILY ELLEN FULK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
3400 MARKET LN, KENOSHA, WI 53144-3430
(262) 551-4600
Mailing address
816 CORNERSTONE XING APT 12, WATERFORD, WI 53185-4540
(309) 530-5060
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
7435-23
WI
363AM0700X
Medical Physician Assistant
7435-23
WI
Other
Enumeration date
08/14/2023
Last updated
12/27/2024
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