Provider Demographics
NPI:1750047619
Name:FULLER, SARAH LYNN
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:LYNN
Last Name:FULLER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:71 BUFFALO ST
Mailing Address - Street 2:
Mailing Address - City:HORNELL
Mailing Address - State:NY
Mailing Address - Zip Code:14843-1507
Mailing Address - Country:US
Mailing Address - Phone:607-324-1304
Mailing Address - Fax:607-324-1301
Practice Address - Street 1:71 BUFFALO ST
Practice Address - Street 2:
Practice Address - City:HORNELL
Practice Address - State:NY
Practice Address - Zip Code:14843-1507
Practice Address - Country:US
Practice Address - Phone:607-324-1304
Practice Address - Fax:607-324-1301
Is Sole Proprietor?:No
Enumeration Date:2021-11-15
Last Update Date:2021-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY688642-01163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool