Individual
MISS REBECCA LYNN FULLER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RD, CDN
Contact information
Practice address
3229 E GENESEE ST, SYRACUSE, NY 13214-2016
(917) 455-5513
Mailing address
410 RITA DR, SYRACUSE, NY 13212-2621
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
009116-1
NY
Other
Enumeration date
08/31/2017
Last updated
08/31/2017
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