Provider Demographics
NPI:1699305714
Name:FULMER, ERICCA LYNNMARIE (NP)
Entity type:Individual
Prefix:
First Name:ERICCA
Middle Name:LYNNMARIE
Last Name:FULMER
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:651 COLLIERS WAY STE 300
Mailing Address - Street 2:
Mailing Address - City:WEIRTON
Mailing Address - State:WV
Mailing Address - Zip Code:26062-5058
Mailing Address - Country:US
Mailing Address - Phone:304-797-6404
Mailing Address - Fax:
Practice Address - Street 1:560 STEUBENVILLE PIKE
Practice Address - Street 2:
Practice Address - City:BURGETTSTOWN
Practice Address - State:PA
Practice Address - Zip Code:15021-8539
Practice Address - Country:US
Practice Address - Phone:724-947-5350
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-16
Last Update Date:2020-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV105092363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty