Provider Demographics
NPI:1104178540
Name:PHILLIPA GILL-FULCHER
Entity Type:Organization
Organization Name:PHILLIPA GILL-FULCHER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REGISTERED NURSE
Authorized Official - Prefix:MS
Authorized Official - First Name:PHILLIPA
Authorized Official - Middle Name:
Authorized Official - Last Name:GILL-FULCHER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-776-8889
Mailing Address - Street 1:22746 MURDOCK AVE
Mailing Address - Street 2:
Mailing Address - City:QUEENS VILLAGE
Mailing Address - State:NY
Mailing Address - Zip Code:11429-2731
Mailing Address - Country:US
Mailing Address - Phone:718-776-8889
Mailing Address - Fax:
Practice Address - Street 1:22746 MURDOCK AVE
Practice Address - Street 2:
Practice Address - City:QUEENS VILLAGE
Practice Address - State:NY
Practice Address - Zip Code:11429-2731
Practice Address - Country:US
Practice Address - Phone:718-776-8889
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-10
Last Update Date:2012-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY440703313M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility