Provider Demographics
NPI:1114403557
Name:FULWISE, DRUCILLA (CPHT)
Entity Type:Individual
Prefix:
First Name:DRUCILLA
Middle Name:
Last Name:FULWISE
Suffix:
Gender:F
Credentials:CPHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6070 MOORES MILL RD
Mailing Address - Street 2:
Mailing Address - City:HUNTSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35811-9260
Mailing Address - Country:US
Mailing Address - Phone:256-852-4267
Mailing Address - Fax:
Practice Address - Street 1:6070 MOORES MILL RD
Practice Address - Street 2:
Practice Address - City:HUNTSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35811-9260
Practice Address - Country:US
Practice Address - Phone:256-852-4267
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-18
Last Update Date:2018-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174H00000XOther Service ProvidersHealth Educator