Healthcare Provider Details

I. General information

NPI: 1083398044
Provider Name (Legal Business Name): TERESA A FULCHER BSN, RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/12/2023
Last Update Date: 06/12/2023
Certification Date: 06/11/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9 MAITLAND AVE
RANDOLPH MA
02368-3209
US

IV. Provider business mailing address

9 MAITLAND AVE
RANDOLPH MA
02368-3209
US

V. Phone/Fax

Practice location:
  • Phone: 508-345-2617
  • Fax:
Mailing address:
  • Phone: 508-345-2617
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN2324750
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code163WC3500X
TaxonomyCardiac Rehabilitation Registered Nurse
License NumberRN2324750
License Number StateMA
# 3
Primary TaxonomyN
Taxonomy Code163WI0500X
TaxonomyInfusion Therapy Registered Nurse
License NumberRN2324750
License Number StateMA
# 4
Primary TaxonomyN
Taxonomy Code163WM0705X
TaxonomyMedical-Surgical Registered Nurse
License NumberRN2324750
License Number StateMA
# 5
Primary TaxonomyN
Taxonomy Code163WP0809X
TaxonomyAdult Psychiatric/Mental Health Registered Nurse
License NumberRN2324750
License Number StateMA
# 6
Primary TaxonomyN
Taxonomy Code163WW0000X
TaxonomyWound Care Registered Nurse
License NumberRN2324750
License Number StateMA
# 7
Primary TaxonomyN
Taxonomy Code163WX0003X
TaxonomyInpatient Obstetric Registered Nurse
License NumberRN2324750
License Number StateMA
# 8
Primary TaxonomyY
Taxonomy Code163WG0000X
TaxonomyGeneral Practice Registered Nurse
License NumberRN2324750
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: