Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363L00000X | Nurse Practitioner | SP013013 | PA |
NPI | 1003244252 |
---|---|
Provider Name | Ahna D Fulmer |
First Address | Harrisburg, PA 17104-1612 |
Second Address | Lititz, PA 17543-7694 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/10/2013 |
Last Update Date | 09/04/2018 |