Provider Demographics
NPI:1972808939
Name:FULENA, ANDREA M (MT)
Entity Type:Individual
Prefix:
First Name:ANDREA
Middle Name:M
Last Name:FULENA
Suffix:
Gender:F
Credentials:MT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6119 NEW PEMBROOK LN
Mailing Address - Street 2:
Mailing Address - City:FREDERICKSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22407-8378
Mailing Address - Country:US
Mailing Address - Phone:540-220-4904
Mailing Address - Fax:
Practice Address - Street 1:6330 FIVE MILE CENTRE PARK
Practice Address - Street 2:SUITE 406
Practice Address - City:FREDERICKSBURG
Practice Address - State:VA
Practice Address - Zip Code:22407
Practice Address - Country:US
Practice Address - Phone:540-785-9770
Practice Address - Fax:540-785-9772
Is Sole Proprietor?:No
Enumeration Date:2011-01-21
Last Update Date:2011-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0019007537208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation