Provider Demographics
NPI:1821213661
Name:FULMER, DENISE SUZANNE (RN)
Entity Type:Individual
Prefix:MRS
First Name:DENISE
Middle Name:SUZANNE
Last Name:FULMER
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 1:1726 MARILYN LANE
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45231-5223
Mailing Address - Country:US
Mailing Address - Phone:513-521-8955
Mailing Address - Fax:
Practice Address - Street 1:1726 MARILYN AVE
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45231-5223
Practice Address - Country:US
Practice Address - Phone:513-207-3603
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-16
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH289933163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2646597Medicaid