Individual
CHEYENNE FULLER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
186 BILTMORE AVE, ELMONT, NY 11003-1513
(516) 303-6263
Mailing address
186 BILTMORE AVE, ELMONT, NY 11003-1513
(516) 303-6263
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
345483
NY
Other
Enumeration date
06/28/2023
Last updated
06/28/2023
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