Provider Demographics
NPI:1942744065
Name:FULMORE, WENETTE
Entity Type:Individual
Prefix:
First Name:WENETTE
Middle Name:
Last Name:FULMORE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14170 SW 30TH PL
Mailing Address - Street 2:
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34481-5210
Mailing Address - Country:US
Mailing Address - Phone:352-348-1952
Mailing Address - Fax:
Practice Address - Street 1:14170 SW 30TH PL
Practice Address - Street 2:
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34481-5210
Practice Address - Country:US
Practice Address - Phone:352-348-1952
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-12-08
Last Update Date:2016-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist