Provider Demographics
NPI:1720469117
Name:FULIE, KILIAN (FNP)
Entity Type:Individual
Prefix:MR
First Name:KILIAN
Middle Name:
Last Name:FULIE
Suffix:
Gender:M
Credentials:FNP
Other - Prefix:
Other - First Name:KILIAN
Other - Middle Name:
Other - Last Name:FULIE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:FNP
Mailing Address - Street 1:51362 BRUSHFORD DR
Mailing Address - Street 2:
Mailing Address - City:CHESTERFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48047-3175
Mailing Address - Country:US
Mailing Address - Phone:248-571-2274
Mailing Address - Fax:
Practice Address - Street 1:51362 BRUSHFORD DR
Practice Address - Street 2:
Practice Address - City:CHESTERFIELD
Practice Address - State:MI
Practice Address - Zip Code:48047-3175
Practice Address - Country:US
Practice Address - Phone:248-571-2274
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-11
Last Update Date:2023-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704345633NSA23363L00000X
MI4703115042164W00000X
MI4704345633163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No164W00000XNursing Service ProvidersLicensed Practical Nurse