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Individual

MS. KOLLEEN MARIAN FULLER

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
RNNP

Contact information

Practice address
736 IRVING AVE, SYRACUSE, NY 13210-1687
(315) 470-7111
(315) 470-2642
Mailing address
57 FENNELL ST, SKANEATELES, NY 13152-1119
(315) 685-0023

Taxonomy

Speciality
Code
Description
License number
State
363LA2100X
Acute Care Nurse Practitioner
Primary
300761-1
NY

Other

Enumeration date
03/30/2007
Last updated
07/08/2007
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