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General NPI Number Information
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NPI Number | 1972552131
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Entity Type | Individual
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Provider Name | ANDREA B FULCOMER PA-C
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Gender | Female
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Dates
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Enumeration Date | 05/08/2006
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Last Update Date | 10/13/2025
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Provider Practice Location Address
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Address Line | 5543 E CHERYL PKWY
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City | FITCHBURG
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State | WI
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Zip | 53711-5376
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Country | US
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Telephone | 608-274-5300
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Fax |
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Provider Business Mailing Address
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Address Line | 7974 UW HEALTH CT
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City | MIDDLETON
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State | WI
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Zip | 53562-5531
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Country | US
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Telephone |
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Fax |
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 7152
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License Number State | WI
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Taxonomy #2
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 50-00-1216
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License Number State | OH
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Taxonomy #3
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 085.004757
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License Number State | IL
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