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Individual

ALISHA M FULLER

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
FNP

Contact information

Practice address
390 CRYSTAL RUN RD, SUITE 102, MIDDLETOWN, NY 10941
(845) 692-8780
(845) 692-3439
Mailing address
390 CRYSTAL RUN RD, SUITE 102, MIDDLETOWN, NY 10941
(845) 692-8780
(845) 692-3439

Taxonomy

Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
333950
NY

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
02745279
NY
Enumeration date
08/15/2005
Last updated
10/31/2008
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