Individual
DR. REBECCA L. FULTON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
415 6TH ST, PATHOLOGISTS' REGIONAL LABORATORY, LEWISTON, ID 83501-2431
(208) 746-0516
(208) 746-4989
Mailing address
415 6TH ST, PATHOLOGISTS' REGIONAL LABORATORY, LEWISTON, ID 83501-2431
(208) 746-0516
(208) 746-4989
Taxonomy
Speciality
Code
Description
License number
State
207ZP0102X
Anatomic Pathology & Clinical Pathology Physician
Primary
M-11363
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
002335400
—
WA
05
—
002335700
—
ID
Enumeration date
11/15/2007
Last updated
10/29/2014
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