Provider Demographics
NPI:1558991257
Name:FULTON, JANICE (RN)
Entity Type:Individual
Prefix:
First Name:JANICE
Middle Name:
Last Name:FULTON
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:724 POSTAL SERVICE LOOP STOP 7499
Mailing Address - Street 2:
Mailing Address - City:FORT RICHARDSON
Mailing Address - State:AK
Mailing Address - Zip Code:99505-7499
Mailing Address - Country:US
Mailing Address - Phone:907-384-7157
Mailing Address - Fax:907-384-1406
Practice Address - Street 1:724 POSTAL SERVICE LOOP STOP 7499
Practice Address - Street 2:
Practice Address - City:FORT RICHARDSON
Practice Address - State:AK
Practice Address - Zip Code:99505-7499
Practice Address - Country:US
Practice Address - Phone:907-384-7157
Practice Address - Fax:907-384-1406
Is Sole Proprietor?:No
Enumeration Date:2020-01-22
Last Update Date:2020-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MERN16087163WC0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0400XNursing Service ProvidersRegistered NurseCase Management