Provider Demographics
NPI:1861088445
Name:FULTON, DANIEL ARTHUR
Entity type:Individual
Prefix:
First Name:DANIEL
Middle Name:ARTHUR
Last Name:FULTON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6864 WEXFORD HILL LN
Mailing Address - Street 2:
Mailing Address - City:HOLLAND
Mailing Address - State:OH
Mailing Address - Zip Code:43528-8140
Mailing Address - Country:US
Mailing Address - Phone:419-270-0469
Mailing Address - Fax:
Practice Address - Street 1:6864 WEXFORD HILL LN
Practice Address - Street 2:
Practice Address - City:HOLLAND
Practice Address - State:OH
Practice Address - Zip Code:43528-8140
Practice Address - Country:US
Practice Address - Phone:419-270-0469
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-17
Last Update Date:2021-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2246484Medicaid