MEDICARE: MRS. VALERIE DAWN FULTON APN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LW0102X	Women's Health Nurse Practitioner	SP010784	PA
2	363LW0102X	Women's Health Nurse Practitioner	26NN10281700	NJ

General Provider Information

NPI Number	:	1588664577
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. VALERIE DAWN FULTON APN

Provider Business Mailing Address
First Line	:	301 LIPPINCOTT DR STE 410
Second Line	:
City	:	MARLTON
State	:	NJ
Zip	:	08053-4197
Country	:	US
Telephone Number	:	856-355-0340
Fax Number	:	856-355-0330

Provider Business Practice Location Address
First Line	:	6981 N PARK DR STE 300A
Second Line	:
City	:	PENNSAUKEN
State	:	NJ
Zip	:	08109-4205
Country	:	US
Telephone Number	:	856-854-4524
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/30/2005
Last Update Date	:	08/14/2024

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