Provider Demographics
NPI:1083059083
Name:FULMER, PATRICIA MANN (REGISTERED NURSE)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:MANN
Last Name:FULMER
Suffix:
Gender:F
Credentials:REGISTERED NURSE
Other - Prefix:
Other - First Name:PATRICIA
Other - Middle Name:ANNE
Other - Last Name:FULMER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:REGISTRED NURSE
Mailing Address - Street 1:2924 MACEDONIA CHURCH RD
Mailing Address - Street 2:
Mailing Address - City:PROSPERITY
Mailing Address - State:SC
Mailing Address - Zip Code:29127-9045
Mailing Address - Country:US
Mailing Address - Phone:803-364-4057
Mailing Address - Fax:
Practice Address - Street 1:2924 MACEDONIA CHURCH RD
Practice Address - Street 2:
Practice Address - City:PROSPERITY
Practice Address - State:SC
Practice Address - Zip Code:29127-9045
Practice Address - Country:US
Practice Address - Phone:803-364-4057
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-05-03
Last Update Date:2013-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC87679390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program