Provider Demographics
NPI:1730995978
Name:FULLER, MELYNDA (RN MSN BSN)
Entity type:Individual
Prefix:
First Name:MELYNDA
Middle Name:
Last Name:FULLER
Suffix:
Gender:F
Credentials:RN MSN BSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:108 PARKRIDGE CT
Mailing Address - Street 2:
Mailing Address - City:ROCKY MOUNT
Mailing Address - State:NC
Mailing Address - Zip Code:27804-8464
Mailing Address - Country:US
Mailing Address - Phone:215-964-8255
Mailing Address - Fax:
Practice Address - Street 1:108 PARKRIDGE CT
Practice Address - Street 2:
Practice Address - City:ROCKY MOUNT
Practice Address - State:NC
Practice Address - Zip Code:27804-8464
Practice Address - Country:US
Practice Address - Phone:215-964-8255
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-03
Last Update Date:2024-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95184268163WC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC1500XNursing Service ProvidersRegistered NurseCommunity Health