Individual
MRS. REBECCA LU FULTZ
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
RN
Contact information
Practice address
1848 93RD AVE APT C, DRESSER, WI 54009-4627
(171) 555-4204
Mailing address
1848 93RD AVE APT C, DRESSER, WI 54009-4627
(171) 555-4204
Taxonomy
Speciality
Code
Description
License number
State
163WC0400X
Case Management Registered Nurse
Primary
174688-030
WI
164W00000X
Licensed Practical Nurse
306538-031
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3950845470
—
WI
Enumeration date
05/19/2008
Last updated
05/23/2011
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