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Individual
MS. STACIE MARIE FULCHER
Active
Individual
MS. STACIE MARIE FULCHER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PA-C
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
1014
NE
363A00000X
Physician Assistant
PA154004
OR
363AM0700X
Medical Physician Assistant
Primary
PA154004
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
500642760
—
OR
Enumeration date
01/15/2008
Last updated
06/20/2024
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