Individual
LOURDES SOFIA FULCOMER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
FNP
Contact information
Practice address
4 FULLER ST, ALEXANDRIA BAY, NY 13607-1391
(315) 482-1125
Mailing address
4 FULLER ST, ALEXANDRIA BAY, NY 13607-1391
(315) 482-2511
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
803858
NY
363L00000X
Nurse Practitioner
Primary
351959
NY
Other
Enumeration date
06/19/2023
Last updated
06/19/2023
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