Healthcare Provider Details

I. General information

NPI: 1356862247
Provider Name (Legal Business Name): BERNADETTE FULWEILER CPNP-PC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/29/2017
Last Update Date: 01/28/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 ROCKLAND RD
WILMINGTON DE
19803-3607
US

IV. Provider business mailing address

1600 ROCKLAND RD
WILMINGTON DE
19803-3607
US

V. Phone/Fax

Practice location:
  • Phone: 302-651-4200
  • Fax: 302-651-5951
Mailing address:
  • Phone: 302-651-4200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WP0200X
TaxonomyPediatric Registered Nurse
License Number667138-1
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberSP018760
License Number StatePA
# 3
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberLJ-0000340
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: