Provider Demographics
NPI:1710960042
Name:FULMER BRASEL, MARGARET MARIE (CERTIFIED NURSE MIDW)
Entity Type:Individual
Prefix:
First Name:MARGARET
Middle Name:MARIE
Last Name:FULMER BRASEL
Suffix:
Gender:F
Credentials:CERTIFIED NURSE MIDW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 21709
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37424-0709
Mailing Address - Country:US
Mailing Address - Phone:423-648-6020
Mailing Address - Fax:423-648-6025
Practice Address - Street 1:7490 ZIEGLER RD
Practice Address - Street 2:
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37421-3156
Practice Address - Country:US
Practice Address - Phone:423-648-6020
Practice Address - Fax:423-648-6025
Is Sole Proprietor?:No
Enumeration Date:2005-11-21
Last Update Date:2011-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN138198367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife