Individual
CARLA JUDITH FULLER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LPN
Contact information
Practice address
88 E MAIN ST, HORNELL, NY 14843-2074
(585) 201-6166
Mailing address
9 HUGHES ST E, PO BOX 316, BELFAST, NY 14711-8725
(585) 201-6166
Taxonomy
Speciality
Code
Description
License number
State
3140N1450X
Pediatric Skilled Nursing Facility
Primary
217696-1
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
02713931
—
NY
Enumeration date
11/20/2007
Last updated
11/20/2007
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