Provider Demographics
NPI:1235885708
Name:FULCHER, REGINA ROSE (RN)
Entity Type:Individual
Prefix:
First Name:REGINA
Middle Name:ROSE
Last Name:FULCHER
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2139 EGG FARM RD
Mailing Address - Street 2:
Mailing Address - City:PATRICK SPRINGS
Mailing Address - State:VA
Mailing Address - Zip Code:24133-3409
Mailing Address - Country:US
Mailing Address - Phone:276-732-6162
Mailing Address - Fax:276-629-3259
Practice Address - Street 1:2139 EGG FARM RD
Practice Address - Street 2:
Practice Address - City:PATRICK SPRINGS
Practice Address - State:VA
Practice Address - Zip Code:24133-3409
Practice Address - Country:US
Practice Address - Phone:276-732-6162
Practice Address - Fax:276-629-3259
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-23
Last Update Date:2022-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0001143429163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health