1083059083 NPI number — PATRICIA MANN FULMER REGISTERED NURSE

Table of content: PATRICIA MANN FULMER REGISTERED NURSE (NPI 1083059083)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1083059083 NPI number — PATRICIA MANN FULMER REGISTERED NURSE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
FULMER
Provider First Name:
PATRICIA
Provider Middle Name:
MANN
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
REGISTERED NURSE
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
FULMER
Provider Other First Name:
PATRICIA
Provider Other Middle Name:
ANNE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
REGISTRED NURSE
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1083059083
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/03/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2924 MACEDONIA CHURCH RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PROSPERITY
Provider Business Mailing Address State Name:
SC
Provider Business Mailing Address Postal Code:
29127-9045
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
803-364-4057
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2924 MACEDONIA CHURCH RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PROSPERITY
Provider Business Practice Location Address State Name:
SC
Provider Business Practice Location Address Postal Code:
29127-9045
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
803-364-4057
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/03/2013

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 390200000X , with the licence number:  87679 , registered in the state of SC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)