Provider Demographics
NPI:1497383962
Name:FULTON, VALERIE ANN (RN, MSN)
Entity Type:Individual
Prefix:
First Name:VALERIE
Middle Name:ANN
Last Name:FULTON
Suffix:
Gender:F
Credentials:RN, MSN
Other - Prefix:
Other - First Name:VALERIE
Other - Middle Name:ANN
Other - Last Name:FULLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:UNIVERSITY HEALTH SERVICES
Mailing Address - Street 2:459 STUDENT HEALTH CENTER
Mailing Address - City:UNIVERSITY PARK
Mailing Address - State:PA
Mailing Address - Zip Code:16802
Mailing Address - Country:US
Mailing Address - Phone:814-865-2400
Mailing Address - Fax:
Practice Address - Street 1:PENN STATE UNIVERSITY UNIVERSITY HEALTH SERVICES
Practice Address - Street 2:STUDENT HEALTH CENTER
Practice Address - City:UNIVERSITY PARK
Practice Address - State:PA
Practice Address - Zip Code:16802
Practice Address - Country:US
Practice Address - Phone:814-865-2400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-31
Last Update Date:2020-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN523915L163WI0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WI0600XNursing Service ProvidersRegistered NurseInfection Control
Provider Identifiers
StateIdentifier IDID TypeIssuer
PARN523915LOtherPA NURSING LICENSE