Individual
STEPHANIE MARIE FULKS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
DNP
Contact information
Practice address
1500 N RITTER AVE, INDIANAPOLIS, IN 46219-3027
(317) 918-3848
Mailing address
11110 WOODBURY DR, CARMEL, IN 46033-3788
(317) 918-3848
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
28229839A
IN
363LA2100X
Acute Care Nurse Practitioner
Primary
71013487A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
28229839A
NURSING BOARD LICENSE
IN
01
—
71013487A
APRN PRESCRIPTIVE AUTHORITY LICENSE
IN
Enumeration date
01/23/2023
Last updated
01/23/2023
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