Provider Demographics
NPI:1013206010
Name:FULTON, JILL ELIZABETH (CRNA)
Entity Type:Individual
Prefix:MRS
First Name:JILL
Middle Name:ELIZABETH
Last Name:FULTON
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:835 HOSPITAL RD
Mailing Address - Street 2:PO BOX 788
Mailing Address - City:INDIANA
Mailing Address - State:PA
Mailing Address - Zip Code:15701-3629
Mailing Address - Country:US
Mailing Address - Phone:724-357-7009
Mailing Address - Fax:
Practice Address - Street 1:835 HOSPITAL RD
Practice Address - Street 2:ANESTHESIOLOGY DEPARTMENT
Practice Address - City:INDIANA
Practice Address - State:PA
Practice Address - Zip Code:15701-3629
Practice Address - Country:US
Practice Address - Phone:724-357-7218
Practice Address - Fax:724-357-7475
Is Sole Proprietor?:No
Enumeration Date:2011-03-31
Last Update Date:2011-03-31
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PARN533344367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered