Healthcare Provider Details

I. General information

NPI: 1407059538
Provider Name (Legal Business Name): ANNA FAUCHER FULTON RNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/06/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1681 CRANSTON ST
CRANSTON RI
02920-5000
US

IV. Provider business mailing address

1681 CRANSTON ST
CRANSTON RI
02920-5000
US

V. Phone/Fax

Practice location:
  • Phone: 401-946-8446
  • Fax: 401-946-8340
Mailing address:
  • Phone: 401-946-8446
  • Fax: 401-946-8340

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberNPP22114
License Number StateRI
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN22114
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: