Individual
MISS CONNIE ANN FULTON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LPN
Contact information
Practice address
3548 SOUTH ST MADISON, MADISON 13402, NY 13402
(315) 368-4583
Mailing address
PO BOX 312, MADISON, NY 13402-0312
(315) 368-4583
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
280482-1
NY
Other
Enumeration date
11/19/2009
Last updated
11/19/2009
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