1679822043 NPI number — MRS. NADINE A FULLING FNP-BC, CLC

Table of content: MRS. NADINE A FULLING FNP-BC, CLC (NPI 1679822043)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1679822043 NPI number — MRS. NADINE A FULLING FNP-BC, CLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
FULLING
Provider First Name:
NADINE
Provider Middle Name:
A
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
FNP-BC, CLC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1679822043
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/13/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4 COACHMAN RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WINDHAM
Provider Business Mailing Address State Name:
NH
Provider Business Mailing Address Postal Code:
03087-1677
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
603-401-1882
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
20 FOUNDRY ST FL 2
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CONCORD
Provider Business Practice Location Address State Name:
NH
Provider Business Practice Location Address Postal Code:
03301-5419
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
888-731-8994
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/31/2012

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: 363LF0000X , with the licence number:  RN2274501 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





Copyright © 2007-2025 www.npivalidator.com