Individual
LINDA MARIE FULLER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
ANP, CDE
Contact information
Practice address
701 SENECA ST STE 646C, BUFFALO, NY 14210-1351
(716) 995-4450
Mailing address
515 SWAN STREET, DUNKIRK, NY 14048-9766
(716) 366-7331
(716) 363-5228
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
369389-1
NY
363LA2200X
Adult Health Nurse Practitioner
Primary
306314
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
369389-1
NYS NURSING LICENSE
NY
Enumeration date
02/27/2008
Last updated
10/24/2019
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