Healthcare Provider Details

I. General information

NPI: 1841468386
Provider Name (Legal Business Name): JEANNE DALENE FULCHER N.N.P.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/19/2008
Last Update Date: 04/20/2023
Certification Date: 04/20/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2954 S EUGENE
MESA AZ
85212-1782
US

IV. Provider business mailing address

PO BOX 5177
PHOENIX AZ
85010-5177
US

V. Phone/Fax

Practice location:
  • Phone: 800-243-3839
  • Fax:
Mailing address:
  • Phone: 602-344-5651
  • Fax: 602-344-5683

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WN0002X
TaxonomyNeonatal Intensive Care Registered Nurse
License NumberRN037765
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code363LN0000X
TaxonomyNeonatal Nurse Practitioner
License NumberAP5949
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: