Individual
TERRANCE TYREE FULTON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
5223 N 48TH AVE, OMAHA, NE 68104-2378
(402) 979-5633
Mailing address
5223 N 48TH AVE, OMAHA, NE 68104-2378
(402) 979-5633
Taxonomy
Speciality
Code
Description
License number
State
372600000X
Adult Companion
Primary
—
—
Other
Enumeration date
01/05/2026
Last updated
01/05/2026
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