Individual
MRS. ELIZABETH ANNE MARIE FULKS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CPNP-AC
Contact information
Practice address
4201 SAINT ANTOINE ST, DETROIT, MI 48201-2153
(313) 745-4405
Mailing address
4201 SAINT ANTOINE ST # 5D, DETROIT, MI 48201-2153
(313) 745-4405
Taxonomy
Speciality
Code
Description
License number
State
363LA2100X
Acute Care Nurse Practitioner
4704306489
MI
363LP0200X
Pediatric Nurse Practitioner
Primary
4704306489
MI
Other
Enumeration date
09/05/2018
Last updated
09/05/2018
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