Trene Lynn Fulton

Key facts

NPI

1144052986

Entity type

Individual (NPI type 1)

Primary specialty

Behavior Technician 106S00000X

Practice address

19853 Outer Dr Ste 110
Dearborn, MI 48124-2044

Phone

(313) 406-5056

NPI assigned

Aug 19, 2024

Sex

Female

Sole proprietor

Yes

Medicare participation

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)

No

Specialties & licenses

Addresses

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Aug 19, 2024.

{
    "created_epoch": "1724025600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1724025600000",
    "number": "1144052986",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "19853 OUTER DR STE 110",
            "city": "DEARBORN",
            "state": "MI",
            "postal_code": "481242044",
            "telephone_number": "313-406-5056"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "19853 OUTER DR STE 110",
            "city": "DEARBORN",
            "state": "MI",
            "postal_code": "481242044",
            "telephone_number": "313-406-5056"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FULTON",
        "first_name": "TRENE",
        "middle_name": "LYNN",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2024-08-19",
        "last_updated": "2024-08-19",
        "certification_date": "2024-08-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "106S00000X",
            "taxonomy_group": "",
            "desc": "Behavior Technician",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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All providers in Dearborn, MI · Behavior Technician in Michigan