Provider Demographics
NPI:1619974227
Name:FULK, NONA P (MD)
Entity Type:Individual
Prefix:
First Name:NONA
Middle Name:P
Last Name:FULK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:NONA
Other - Middle Name:P
Other - Last Name:PAWLAK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1300 FRANKLIN AVE STE 330
Mailing Address - Street 2:
Mailing Address - City:NORMAL
Mailing Address - State:IL
Mailing Address - Zip Code:61761-4204
Mailing Address - Country:US
Mailing Address - Phone:309-808-0940
Mailing Address - Fax:309-808-0799
Practice Address - Street 1:1300 FRANKLIN AVE STE 330
Practice Address - Street 2:
Practice Address - City:NORMAL
Practice Address - State:IL
Practice Address - Zip Code:61761-4204
Practice Address - Country:US
Practice Address - Phone:309-808-0940
Practice Address - Fax:309-808-0799
Is Sole Proprietor?:No
Enumeration Date:2005-06-29
Last Update Date:2024-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036096101207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036096101Medicaid
H02997Medicare UPIN
K19932Medicare ID - Type Unspecified