Provider Demographics
NPI:1457180689
Name:FULLIN, EVA FAYE (PA)
Entity type:Individual
Prefix:
First Name:EVA
Middle Name:FAYE
Last Name:FULLIN
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:EVA
Other - Middle Name:FAYE
Other - Last Name:FULLIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:145 PARK ST APT 2
Mailing Address - Street 2:
Mailing Address - City:BEVERLY
Mailing Address - State:MA
Mailing Address - Zip Code:01915-3224
Mailing Address - Country:US
Mailing Address - Phone:508-560-0102
Mailing Address - Fax:
Practice Address - Street 1:1260 ELM STREET
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:NH
Practice Address - Zip Code:03101
Practice Address - Country:US
Practice Address - Phone:603-314-1701
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-27
Last Update Date:2024-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant