Provider Demographics
NPI:1245428879
Name:FULMER, RIENNA P (PA-C)
Entity type:Individual
Prefix:
First Name:RIENNA
Middle Name:P
Last Name:FULMER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:RIENNA
Other - Middle Name:P
Other - Last Name:DEMEO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:2106 HARRISBURG PIKE
Mailing Address - Street 2:SUITE 116
Mailing Address - City:LANCASTER
Mailing Address - State:PA
Mailing Address - Zip Code:17601-2644
Mailing Address - Country:US
Mailing Address - Phone:717-393-1900
Mailing Address - Fax:888-972-8301
Practice Address - Street 1:2106 HARRISBURG PIKE
Practice Address - Street 2:SUITE 116
Practice Address - City:LANCASTER
Practice Address - State:PA
Practice Address - Zip Code:17601-2644
Practice Address - Country:US
Practice Address - Phone:717-393-1900
Practice Address - Fax:888-972-8301
Is Sole Proprietor?:No
Enumeration Date:2007-10-09
Last Update Date:2015-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA053169363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA137027D1XMedicare PIN