Provider Demographics
NPI:1083818389
Name:FULLER, REBECCA BALDWIN (NP)
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:BALDWIN
Last Name:FULLER
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:44035 RIVERSIDE PKWY STE 300
Mailing Address - Street 2:
Mailing Address - City:LEESBURG
Mailing Address - State:VA
Mailing Address - Zip Code:20176-8260
Mailing Address - Country:US
Mailing Address - Phone:703-554-6800
Mailing Address - Fax:703-724-7503
Practice Address - Street 1:80 MADDEX DR
Practice Address - Street 2:
Practice Address - City:SHEPHERDSTOWN
Practice Address - State:WV
Practice Address - Zip Code:25443-4305
Practice Address - Country:US
Practice Address - Phone:304-876-9422
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-12
Last Update Date:2024-10-23
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY304631363LA2200X
VA0024168084363LA2200X
WV120365363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health