Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 2080P0214X | Pediatric Pulmonologist | MA059885 | PA |
NPI | 1598024317 |
---|---|
Provider Name | Rachel Erin Fultz |
First Address | Hershey, PA 17033-2360 |
Second Address | Hershey, PA 17033 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 14/05/2012 |
Last Update Date | 22/11/2019 |