Kolleen Marian Fuller, RNNP

Primary specialty

Acute Care Nurse PractitionerTaxonomy code 363LA2100X

License

300761-1 Issued in NY

Practice address

736 Irving Ave
Syracuse, NY 13210-1687

Phone

(315) 470-7111

Fax

(315) 470-2642

NPI assigned

Mar 30, 2007

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: No
• Medical equipment: Yes
• Home health: No
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Medicare enrollment (NPD)

Enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1175212800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1952421059",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "57 FENNELL ST",
            "city": "SKANEATELES",
            "state": "NY",
            "postal_code": "131521119",
            "telephone_number": "315-685-0023"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "736 IRVING AVE",
            "city": "SYRACUSE",
            "state": "NY",
            "postal_code": "132101687",
            "telephone_number": "315-470-7111",
            "fax_number": "315-470-2642"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FULLER",
        "first_name": "KOLLEEN",
        "middle_name": "MARIAN",
        "name_prefix": "Ms.",
        "credential": "RNNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-03-30",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LA2100X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Acute Care",
            "state": "NY",
            "license": "300761-1",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Christopher J Fullagar, MD
• Bridget R Fuller, LCSW
• Dale W Fuller, LCSW
• Haley Fuller, CNM
• Jennifer Fuller, LMHC
• Melissa Fuller
• Paul G Fuller Jr., MD
• Rebecca Lynn Fuller, RD, CDN
• Abigail Maureen Funari, MD
• Jennifer Schum Funderburk, PH.D.

• Acute Care Nurse Practitioner in Syracuse, NY
• Providers in Syracuse, NY by specialty
• Acute Care Nurse Practitioner in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.