Healthcare Provider Details

I. General information

NPI: 1528678562
Provider Name (Legal Business Name): DEANNA FULCHER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/04/2020
Last Update Date: 08/05/2026
Certification Date: 08/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

575 E 100 S
PRICE UT
84501-3102
US

IV. Provider business mailing address

PO BOX 867
PRICE UT
84501-0867
US

V. Phone/Fax

Practice location:
  • Phone: 435-637-2358
  • Fax:
Mailing address:
  • Phone: 435-637-7200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number14285077-4405
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: