Individual
BREANNE FULLER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
71 PROSPECT AVE, HUDSON, NY 12534-2907
(518) 791-9482
Mailing address
31 BROOKSIDE DR, SARATOGA SPRINGS, NY 12866-6303
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
018825
NY
Other
Enumeration date
08/19/2015
Last updated
03/16/2018
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