| NPI | 1417407743 |
|---|---|
| Former Name | LAUREN C FULTZ |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner Psychiatric/Mental Health (Licence: IN 71006708A) |
| Enumeration Date | 2016-10-11 |
| Last Update Date | 2018-10-04 |