Individual
MRS. NICOLE YVETTE FULLER-RICHARDSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LPN
Contact information
Practice address
134 WESTSIDE AVE, FREEPORT, NY 11520-5442
(516) 322-0727
(516) 377-1637
Mailing address
134 WESTSIDE AVE, FREEPORT, NY 11520-5442
(516) 322-0727
(516) 377-1637
Taxonomy
Speciality
Code
Description
License number
State
164X00000X
Licensed Vocational Nurse
Primary
262710-1
NY
Other
Enumeration date
08/13/2013
Last updated
08/13/2013
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