| Doctor Name: | MARY R FULLERTON |
| NPI Number: | 1700057338 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | RN |
| License Number: | RN20599 |
| Business Practice Address: | 550 6th Avenue North Wolf Point, MT - 59201 |
| Business Phone Number: | 4066531641 |
| Business Fax Number: | 4066533728 |
| Mailing Address: | 550 6th Avenue North, WOLF POINT |
| State: | MT |
| Postal Code: | 59201 |
| Phone Number: | 4066531641 |
| Fax Number: | 4066533728 |
| NPI Enumeration Date: | 03/24/2008 |
| NPI Last Update Date: | 03/24/2008 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 163WC1500X |
| License Number: | RN20599 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MT |
| Taxonomy Type: | Nursing Service Providers |
| Taxonomy Classification: | Registered Nurse |
| Taxonomy Specialization: | Community Health |
| Taxonomy Definition: | |