Individual
ANTONETTE FULLER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
2639 MAIN ST, GLASTONBURY, CT 06033-2023
(860) 659-1329
Mailing address
2639 MAIN ST, GLASTONBURY, CT 06033-2023
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
14117
CT
Other
Enumeration date
11/06/2024
Last updated
11/25/2024
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