Provider Demographics
NPI:1023828795
Name:FULTON, NATHANIEL D (NMD)
Entity type:Individual
Prefix:
First Name:NATHANIEL
Middle Name:D
Last Name:FULTON
Suffix:
Gender:M
Credentials:NMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4177 W MAGGIE DR
Mailing Address - Street 2:
Mailing Address - City:SAN TAN VALLEY
Mailing Address - State:AZ
Mailing Address - Zip Code:85144-3740
Mailing Address - Country:US
Mailing Address - Phone:815-558-8200
Mailing Address - Fax:
Practice Address - Street 1:4177 W MAGGIE DR
Practice Address - Street 2:
Practice Address - City:SAN TAN VALLEY
Practice Address - State:AZ
Practice Address - Zip Code:85144-3740
Practice Address - Country:US
Practice Address - Phone:815-558-8200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-01-13
Last Update Date:2025-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ23-1805175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath