| Doctor Name: | MRS. MARYANN M FULTON |
| NPI Number: | 1467417972 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | NP |
| License Number: | 128222 |
| Business Practice Address: | 4102 Pinion Dr Usaf Academy, CO - 808402502 |
| Business Phone Number: | 7193335260 |
| Business Fax Number: | |
| Mailing Address: | 4102 Pinion Dr, USAF ACADEMY |
| State: | CO |
| Postal Code: | 808402502 |
| Phone Number: | 7193335260 |
| Fax Number: | |
| NPI Enumeration Date: | 04/18/2006 |
| NPI Last Update Date: | 04/02/2016 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LG0600X |
| License Number: | 128222 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | CO |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Gerontology |
| Taxonomy Definition: | |