Individual
GINA FULATER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
55 MELROY AVE, LACKAWANNA, NY 14218-1658
(716) 675-9724
Mailing address
55 MELROY AVE, LACKAWANNA, NY 14218-1658
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
F338184-1
NY
Other
Enumeration date
07/11/2015
Last updated
07/11/2015
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