Individual
AMBER FULLER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
64 ELMHURST DR, LOCKPORT, NY 14094-8922
(585) 355-8686
Mailing address
64 ELMHURST DR, LOCKPORT, NY 14094-8922
(585) 355-8686
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
309717
NY
Other
Enumeration date
08/11/2016
Last updated
08/11/2016
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