Provider Demographics
NPI:1881256030
Name:FULKERSON, RABAKKA (DAC)
Entity type:Individual
Prefix:
First Name:RABAKKA
Middle Name:
Last Name:FULKERSON
Suffix:
Gender:F
Credentials:DAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:234 WAIANUENUE AVE STE 101
Mailing Address - Street 2:
Mailing Address - City:HILO
Mailing Address - State:HI
Mailing Address - Zip Code:96720-2418
Mailing Address - Country:US
Mailing Address - Phone:808-489-4272
Mailing Address - Fax:
Practice Address - Street 1:234 WAIANUENUE AVE STE 101
Practice Address - Street 2:
Practice Address - City:HILO
Practice Address - State:HI
Practice Address - Zip Code:96720-2418
Practice Address - Country:US
Practice Address - Phone:808-489-4272
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-08
Last Update Date:2023-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIACU1288171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist