Provider Demographics
NPI:1083398044
Name:FULCHER, TERESA A (BSN, RN)
Entity Type:Individual
Prefix:
First Name:TERESA
Middle Name:A
Last Name:FULCHER
Suffix:
Gender:F
Credentials:BSN, RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9 MAITLAND AVE
Mailing Address - Street 2:
Mailing Address - City:RANDOLPH
Mailing Address - State:MA
Mailing Address - Zip Code:02368-3209
Mailing Address - Country:US
Mailing Address - Phone:508-345-2617
Mailing Address - Fax:
Practice Address - Street 1:9 MAITLAND AVE
Practice Address - Street 2:
Practice Address - City:RANDOLPH
Practice Address - State:MA
Practice Address - Zip Code:02368-3209
Practice Address - Country:US
Practice Address - Phone:508-345-2617
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-12
Last Update Date:2023-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN2324750163W00000X, 163WC3500X, 163WI0500X, 163WM0705X, 163WP0809X, 163WW0000X, 163WX0003X, 163WG0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice
No163W00000XNursing Service ProvidersRegistered Nurse
No163WC3500XNursing Service ProvidersRegistered NurseCardiac Rehabilitation
No163WI0500XNursing Service ProvidersRegistered NurseInfusion Therapy
No163WM0705XNursing Service ProvidersRegistered NurseMedical-Surgical
No163WP0809XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, Adult
No163WW0000XNursing Service ProvidersRegistered NurseWound Care
No163WX0003XNursing Service ProvidersRegistered NurseObstetric, Inpatient