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General NPI Number Information
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NPI Number | 1083818389
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Entity Type | Individual
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Provider Name | REBECCA BALDWIN FULLER NP
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Gender | Female
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Dates
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Enumeration Date | 06/12/2007
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Last Update Date | 10/23/2024
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Provider Practice Location Address
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Address Line | 80 MADDEX DR
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City | SHEPHERDSTOWN
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State | WV
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Zip | 25443-4305
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Country | US
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Telephone | 304-876-9422
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Fax |
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Provider Business Mailing Address
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Address Line | 44035 RIVERSIDE PKWY STE 300
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City | LEESBURG
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State | VA
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Zip | 20176-8260
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Country | US
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Telephone | 703-554-6800
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Fax | 703-724-7503
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number | 304631
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number | 0024168084
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License Number State | VA
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Taxonomy #3
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Taxonomy Code | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number | 120365
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License Number State | WV
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