Individual
DOUGLAS M FULLER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
191 N MAIN ST, WELLSVILLE, NY 14895-1150
(585) 593-1100
Mailing address
3157 RIVERSIDE DR, WELLSVILLE, NY 14895-9504
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
318840
NY
367500000X
Certified Registered Nurse Anesthetist
Primary
318840-01
NY
Other
Enumeration date
08/09/2006
Last updated
07/03/2023
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