Doctor Name: | CARLA JUDITH FULLER |
NPI Number: | 1376724211 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | LPN |
License Number: | 217696-1 |
Business Practice Address: | 88 E Main St Hornell, NY - 148432074 |
Business Phone Number: | 5852016166 |
Business Fax Number: | |
Mailing Address: | 9 Hughes St E, Po Box 316 BELFAST |
State: | NY |
Postal Code: | 147118725 |
Phone Number: | 5852016166 |
Fax Number: | |
NPI Enumeration Date: | 11/20/2007 |
NPI Last Update Date: | 11/20/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 3140N1450X |
License Number: | 217696-1 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | NY |
Taxonomy Type: | Nursing & Custodial Care Facilities |
Taxonomy Classification: | Skilled Nursing Facility |
Taxonomy Specialization: | Nursing Care, Pediatric |
Taxonomy Definition: | A nursing care facility designed and staffed for the provision of nursing care and appropriate educational and habilitative/rehabilitative services to children with multiple, complex or profound disabilities that can not be cared for in a less restrictive environment. |