Provider Demographics
NPI:1710493150
Name:FULLER, CHRISTINA LEIGH (FNP-C)
Entity Type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:LEIGH
Last Name:FULLER
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1801 STATE ROUTE 17C
Mailing Address - Street 2:
Mailing Address - City:OWEGO
Mailing Address - State:NY
Mailing Address - Zip Code:13827-3900
Mailing Address - Country:US
Mailing Address - Phone:607-751-4474
Mailing Address - Fax:
Practice Address - Street 1:1801 STATE ROUTE 17C
Practice Address - Street 2:
Practice Address - City:OWEGO
Practice Address - State:NY
Practice Address - Zip Code:13827-3900
Practice Address - Country:US
Practice Address - Phone:607-751-4474
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-12-21
Last Update Date:2017-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY342235363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily