Provider Demographics
NPI:1790208619
Name:FULKERSON SCHAEFFER, SANDRA DANIELLE (MPH, PA-C)
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:DANIELLE
Last Name:FULKERSON SCHAEFFER
Suffix:
Gender:F
Credentials:MPH, PA-C
Other - Prefix:
Other - First Name:SANDRA
Other - Middle Name:DANIELLE
Other - Last Name:FULKERSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:681 CENTER ST NE
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97301-3722
Mailing Address - Country:US
Mailing Address - Phone:503-588-5828
Mailing Address - Fax:503-588-5852
Practice Address - Street 1:1233 EDGEWATER ST NW
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97304-4049
Practice Address - Country:US
Practice Address - Phone:503-378-7526
Practice Address - Fax:503-588-5815
Is Sole Proprietor?:No
Enumeration Date:2017-07-23
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant