Individual
BRIANNA KATHERINE FULLER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
71 PROSPECT AVENUE, HUDSON, NY 12534
(518) 758-6101
Mailing address
71 PROSPECT AVE, HUDSON, NY 12534-2907
(518) 758-6101
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
012528
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
012528
LICENSE
NY
Enumeration date
07/24/2007
Last updated
03/19/2019
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