Susan Fullerton, MSN

Primary specialty

Nurse PractitionerTaxonomy code 363L00000X

License

LG0000136 Issued in DE

Practice address

4923 Ogletown Stanton Rd
Suite 200
Newark, DE 19713-2081

Phone

(302) 225-0451

Fax

(302) 225-0472

NPI assigned

Oct 5, 2005

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Other identifiers 3

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Master of Science - Nursing, Nurse Practitioner

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1128470400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1308096000000",
    "number": "1295722155",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4923 OGLETOWN STANTON RD",
            "address_2": "SUITE 200",
            "city": "NEWARK",
            "state": "DE",
            "postal_code": "197132081",
            "telephone_number": "302-225-0451",
            "fax_number": "302-225-0472"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4923 OGLETOWN STANTON RD",
            "address_2": "SUITE 200",
            "city": "NEWARK",
            "state": "DE",
            "postal_code": "197132081",
            "telephone_number": "302-225-0451",
            "fax_number": "302-225-0472"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FULLERTON",
        "first_name": "SUSAN",
        "credential": "MSN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-10-05",
        "last_updated": "2011-06-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "MD",
            "license": "AC000097",
            "primary": false
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "DE",
            "license": "LG0000136",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "404275100",
            "state": "MD"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1000024659",
            "state": "DE"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0046973",
            "state": "NJ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Kelsey Fryberger, FNP-C
• Tara Marie Frye, PA-C
• FS Tenant Pool I Trust
• Gerard Fulda, MD
• Denise F Fuller, LCSW
• Joseph Fullum
• Samantha Fulton
• Functional Movement Institute
• Functional Testing Solutions LLC
• William B Funk, M.D.

• Nurse Practitioner in Newark, DE
• Providers in Newark, DE by specialty
• Nurse Practitioner in Delaware

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 15, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.