NEIL P FULLAN (NPI# 1447262183) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1447262183 |
| Entity Type | Individual |
| Full Name | NEIL P FULLAN |
| Credential | M.D. |
| Practice Address |
2475 University Ave Ste A Green Bay WI 54302-5099 |
| Practice Telephone | 9204691201 |
| Practice Fax Number | 9204693404 |
| Mailing Telephone | 9204691201 |
| Mailing Fax Number | 9204693404 |
| Enumeration Date | 2006-08-12 |
| Last Update Date | 2018-04-13 |
| Gender Code | M |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 2084P0804X |
Psychiatry & Neurology Specialization: Child & Adolescent Psychiatry |
28230 | WI | Allopathic & Osteopathic Physicians |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 1325 Angels Path, De Pere, WI 541154050 | 9203382855 | 9203389270 |
| Street Address |
2475 UNIVERSITY AVE STE A |
| City | GREEN BAY |
| State | WI |
| Zip Code | 54302-5099 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1295226512 | Pyramid Psychiatric Care, LLC | Psychiatry & Neurology | 2475 University Ave Ste A, Green Bay, WI 54302-5099 | 2018-05-22 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1659721371 | Carissa Marie Sawicki | Counselor | 1234 Main Street, Suite 21, 3rd Floor, Green Bay, WI 54302 | 2016-06-14 |
| 1891181459 | Shannon Rae Mullins | Registered Nurse | 2254 Imperial Ln, Green Bay, WI 54302 | 2015-04-10 |
| 1346667045 | David Howard Jadin | Dentist | 1245 Main St, Green Bay, WI 54302 | 2014-03-20 |
| 1407003577 | Abby Baumgart | Counselor | 1234-21 Main St, Green Bay, WI 54302 | 2008-08-20 |
| 1447441779 | Muller Eyecare Associates Ltd | Optometrist | 1776 E Mason St, Green Bay, WI 54302 | 2007-08-01 |
| 1851385231 | Bornemann Nursing Home Inc | Skilled Nursing Facility | 226 Bornemann St, Green Bay, WI 54302 | 2005-08-31 |
| 1194188706 | Familia Dental Green Bay LLC | Dentist | 1931 Main St., Green Bay, WI 54302 | 2016-03-31 |
| 1255710125 | Kim Lawrence | Social Worker | 1234 Main St., St 21, 3rd Floor, Green Bay, WI 54302 | 2015-05-26 |
| 1255464533 | John Muller | Optometrist | 1776 E Mason St, Green Bay, WI 54302 | 2007-03-14 |
| 1851622005 | Michael Andrew Larkey | Social Worker | 815 Reber St, Green Bay, WI 54302-1116 | 2010-01-27 |
| Find all providers in zip 54302 | ||||
| Taxonomy Code | 2084P0804X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Psychiatry & Neurology |
| Specialization | Child & Adolescent Psychiatry |
| Child & Adolescent Psychiatry is a subspecialty of psychiatry with additional skills and training in the diagnosis and treatment of developmental, behavioral, emotional, and mental disorders of childhood and adolescence. |
| Notes: Source: The American Board of Psychiatry and Neurology, Inc. www.abpn.com [1/1/2007: new definition] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1790775450 | Derek Carl Carlson | Psychiatry & Neurology | 301 E Saint Joseph St, Green Bay, WI 54301-2241 | 2005-10-25 |
| 1356502561 | Jennifer E. Montgomery Fischer | Psychiatry & Neurology | 2680 Vernon Dr, Green Bay, WI 54304-5374 | 2008-06-19 |
| 1578761797 | Richa Aggarwal | Psychiatry & Neurology | 2680 Vernon Dr, Green Bay, WI 54304-5374 | 2007-07-10 |
| 1275518474 | Edward S Orman | Psychiatry & Neurology | 301 E Saint Joseph St, Green Bay, WI 54301-2241 | 2005-12-09 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1104384387 | Center for Emotional Wellness LLC. | Psychiatry & Neurology | W156n8327 Pilgrim Rd Ste 301, Menomonee Fls, WI 53051-3776 | 2019-03-06 |
| 1295000255 | Ilsa Bick | Psychiatry & Neurology | 1099 Highland Dr, Kohler, WI 53044-1306 | 2012-03-09 |
| 1215268453 | Richard Carl Zimmerman | Psychiatry & Neurology | 1282 E. Green Lake Dr., West Bend, WI 53090-9069 | 2010-01-28 |
| 1184800880 | William M Buzogany | Psychiatry & Neurology | W350 S1401 Waterville Road, Lad Lake Inc, Dousman, WI 53118 | 2008-01-14 |
| 1033300199 | Monika Drummond Roots | Psychiatry & Neurology | 3140 Oxford Rd, Madison, WI 53705-2224 | 2007-08-05 |
| 1598974321 | Marta Cristina Muller | Psychiatry & Neurology | 1941 N Battle Creek Rd, Oconomowoc, WI 53066-9468 | 2007-05-21 |
| 1164517082 | Moitreyee Bandyopadhyay Reddy | Psychiatry & Neurology | 9000 W.wisconsin Avenue, Milwaukee, WI 53201-1997 | 2006-10-04 |
| 1639182868 | Thomas E. Wright | Psychiatry & Neurology | 120 East Main Street, Cambridge, WI 53523-0548 | 2006-08-15 |
| 1396761276 | Robert Perzacki | Psychiatry & Neurology | 1820 Appleton Rd, Menasha, WI 54952-1110 | 2006-07-14 |
| 1730134412 | Tracey Cornella-carlson | Psychiatry & Neurology | 721 American Ave Ste 501, Waukesha, WI 53188-5071 | 2006-05-23 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.