Provider Demographics
NPI:1447799085
Name:FULGIUM, ALORA S
Entity Type:Individual
Prefix:
First Name:ALORA
Middle Name:S
Last Name:FULGIUM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ALORA
Other - Middle Name:S
Other - Last Name:MCCOY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:8908 CRAIG RD
Mailing Address - Street 2:
Mailing Address - City:BROKEN BOW
Mailing Address - State:OK
Mailing Address - Zip Code:74728-5560
Mailing Address - Country:US
Mailing Address - Phone:918-859-8697
Mailing Address - Fax:
Practice Address - Street 1:8908 CRAIG RD
Practice Address - Street 2:
Practice Address - City:BROKEN BOW
Practice Address - State:OK
Practice Address - Zip Code:74728-5560
Practice Address - Country:US
Practice Address - Phone:918-859-8697
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-15
Last Update Date:2017-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator