Individual
DR. SHANE AMOUR FULTON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
CNA , MD
Contact information
Practice address
6131 N 16TH ST APT D204, PHOENIX, AZ 85016-1711
(623) 986-6877
Mailing address
6131 N 16TH ST APT D204, PHOENIX, AZ 85016-1711
(623) 986-6877
Taxonomy
Speciality
Code
Description
License number
State
374U00000X
Home Health Aide
—
AZ
376K00000X
Nurse's Aide
Primary
CNA1000056885
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
NONE
NONE
AZ
Enumeration date
03/11/2020
Last updated
11/02/2022
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