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Individual

DESIREE STARR FULLER

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
FNP

Contact information

Practice address
1575 WASHINGTON ST, WATERTOWN, NY 13601-9371
(315) 785-4155
(315) 779-5066
Mailing address
1575 WASHINGTON ST, WATERTOWN, NY 13601-9371
(315) 785-4155
(315) 779-5066

Taxonomy

Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
350713
NY

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
350713
NYSED OP
NY
Enumeration date
11/07/2022
Last updated
11/07/2022
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