Individual
ELI JACOB FULFER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
609 W MAPLE AVE, SPRINGDALE, AR 72764-5335
(479) 530-9754
Mailing address
3109 S 28TH PL APT 1, ROGERS, AR 72758-4720
(479) 530-9754
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
213657
AR
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
213657
AR
Other
Enumeration date
01/05/2024
Last updated
06/11/2025
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