ANDREA B FULCOMER (NPI# 1972552131) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1972552131 |
| Entity Type | Individual |
| Full Name | ANDREA B FULCOMER |
| Credential | PA-C |
| Practice Address |
2404 Charles St Rockford IL 61108-1602 |
| Mailing Address |
Po Box 1567 Rockford IL 61110-0067 |
| Practice Telephone | 7796967910 |
| Mailing Telephone | 7796967150 |
| Enumeration Date | 2006-05-08 |
| Last Update Date | 2017-01-06 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363A00000X | Physician Assistant | 085.004757 | IL | Physician Assistants & Advanced Practice Nursing Providers |
| N | 363A00000X | Physician Assistant | 50-00-1216 | OH | Physician Assistants & Advanced Practice Nursing Providers |
| Street Address |
2404 CHARLES ST |
| City | ROCKFORD |
| State | IL |
| Zip Code | 61108-1602 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1144784026 | Laura L Huszla | Nurse Practitioner | 2404 Charles St, Rockford, IL 61108-1602 | 2019-01-25 |
| 1942741970 | Anna Nielsen | Dietitian, Registered | 2404 Charles St, Rockford, IL 61108-1602 | 2017-03-09 |
| 1598179491 | Marden E Torrijos | Family Medicine | 2404 Charles St, Rockford, IL 61108-1602 | 2014-06-18 |
| 1467893461 | Mackenzie T Worthington | Family Medicine | 2404 Charles St, Rockford, IL 61108 | 2013-07-08 |
| 1821283565 | Snigdha Volety | Family Medicine | 2404 Charles St, Rockford, IL 61108 | 2007-09-06 |
| 1275732091 | Gurpreet Kaur Boparai | Family Medicine | 2404 Charles St, Rockford, IL 61108 | 2007-07-12 |
| 1093827115 | Swedishamerican Hospital | Nurse Practitioner | 2404 Charles St, Rockford, IL 61108 | 2006-08-31 |
| 1538199666 | Beth A Christiansen | Nurse Practitioner | 2404 Charles St, Rockford, IL 61108 | 2006-07-04 |
| 1275562712 | Richard E Deming | Family Medicine | 2404 Charles St, Rockford, IL 61108-1602 | 2006-06-30 |
| 1780613273 | Leynard M Martinez | Family Medicine | 2404 Charles St, Rockford, IL 61108 | 2006-06-30 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1952862617 | Isr Enterprises, Inc. | Homemaker | 129 Phelps Ave, Bldg 10, Ste 1008, Rockford, IL 61108 | 2019-03-26 |
| 1003306465 | Adrienne Nicole Black | Behavior Technician | 519 Woodland Dr, Woodland Dr, Rockford, IL 61108 | 2018-05-11 |
| 1184085201 | Integrative Healing Center, LLC | Clinic/Center | 6019 Fincham Drive, Rockford, IL 61108 | 2016-03-17 |
| 1730547936 | Perryville Dentist PC | Dentist | 845 S Perryville Rd, Unit 119, Rockford, IL 61108 | 2016-02-02 |
| 1023489853 | Nicole Ping Ticknor | Counselor | 433 S. Phelps Ave., Suite 2, Rockford, IL 61108 | 2015-10-20 |
| 1275940348 | Northwest Home Care, Inc. | Home Health | 1437 S. Bell School Road, Suite 7, Rockford, IL 61108 | 2014-07-21 |
| 1487072922 | Alecia Greenlee | Psychiatry & Neurology | Rosecrance Community Mental Health, 3815 Harrison Avenue, Rockford, IL 61108 | 2014-04-02 |
| 1871925446 | Maria Laura Gustafson | Interpreter | 3208 Wesleyan Ave., Rockford, IL 61108 | 2013-08-06 |
| 1346582822 | Joseph Peevey | Pathology | 5666 E State Street, Department of Pathology, Rockford, IL 61108 | 2013-03-21 |
| 1134466923 | James Henry Peck | Hearing Instrument Specialist | 2424 Charles St, Rockford, IL 61108 | 2013-01-14 |
| Find all providers in zip 61108 | ||||
| Taxonomy Code | 363A00000X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Physician Assistant |
| A physician assistant is a person who has successfully completed an accredited education program for physician assistant, is licensed by the state and is practicing within the scope of that license. Physician assistants are formally trained to perform many of the routine, time-consuming tasks a physician can do. In some states, they may prescribe medications. They take medical histories, perform physical exams, order lab tests and x-rays, and give inoculations. Most states require that they work under the supervision of a physician. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1871063776 | Amira Al-basha | Physician Assistant | 1639 N Alpine Rd Ste 380, Rockford, IL 61107-1440 | 2018-12-04 |
| 1578042982 | Alyssa Margaret Vasylyuk | Physician Assistant | 2350 N Rockton Ave Fl 4, Rockford, IL 61103-3600 | 2018-08-08 |
| 1053778456 | Jamie Anticevich | Physician Assistant | 6595 East State Street, Rockford, IL 61108-2542 | 2016-01-15 |
| 1437534666 | Irene Dyer | Physician Assistant | 1560 Red Oak Ln, Rockford, IL 61107-2767 | 2015-07-29 |
| 1215250675 | Krista R Mohamed | Physician Assistant | 1401 E. State St., Swedish American Hospital, Rockford, IL 61104-2315 | 2010-03-12 |
| 1629121009 | Jason A. Kadar | Physician Assistant | 2902 Mcfarland Rd Ste 300, Rockford, IL 61107-6801 | 2007-01-19 |
| 1295805851 | Kristin Lynn King-shank | Physician Assistant | 171 Dogwood Dr Ne, Rockford, MI 49341-7361 | 2006-11-09 |
| 1245263268 | William John Stout | Physician Assistant | 1401 E State Street, Rockford, IL 61104 | 2006-07-10 |
| 1952356040 | Saint Anthony Medical Center | Physician Assistant | 6830 Villagreen Vw, Rockford, IL 61107-5639 | 2006-05-24 |
| 1972595296 | Amy L Ailes Dinello | Physician Assistant | 698 Featherstone Rd, Rockford, IL 61107-6303 | 2005-08-22 |
| Find all providers in ROCKFORD | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.