Healthcare Provider Details

I. General information

NPI: 1093124612
Provider Name (Legal Business Name): MS. AMANDA JEAN FULMER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/07/2014
Last Update Date: 09/16/2026
Certification Date: 09/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

136 E ADAMS ST
COCHRANTON PA
16314-8675
US

IV. Provider business mailing address

136 E ADAMS ST
COCHRANTON PA
16314-8675
US

V. Phone/Fax

Practice location:
  • Phone: 814-795-8040
  • Fax:
Mailing address:
  • Phone: 814-795-8040
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberPC021075
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: