Most Relevant Information
Provider Data
| NPI Number: | 1003273996 |
| Provider Name: | KRISTA L FULLER CRNA |
| Entity Type: | Individual |
| Taxonomy Code: | 367500000X |
| Specialty: | Nurse Anesthetist, Certified Registered |
| License Number: | 599740 |
Most Important Dates
| Enumeration Date: | 01/22/2016 |
| Last Updated: | 01/22/2016 |
Provider Practice Location
214 KING STREET
OGDENSBURG
NY
13669
Practice Location Phone/Fax
| Phone: | 3153933600 |
| Fax: | 3153937250 |
Provider Mailing Location
214 KING STREET
OGDENSBURG
NY
13669
Provider Mailing Phone/Fax
| Phone: | 3153933600 |
| Fax: | 3153937250 |