Provider Demographics
NPI:1578398897
Name:FULLER, HALEY (CNM)
Entity type:Individual
Prefix:
First Name:HALEY
Middle Name:
Last Name:FULLER
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:90 PRESIDENTIAL PLAZA
Mailing Address - Street 2:1ST FL
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13202
Mailing Address - Country:US
Mailing Address - Phone:315-464-5210
Mailing Address - Fax:315-464-2141
Practice Address - Street 1:90 PRESIDENTIAL PLAZA
Practice Address - Street 2:1ST FL
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13202
Practice Address - Country:US
Practice Address - Phone:315-464-5210
Practice Address - Fax:315-464-2141
Is Sole Proprietor?:No
Enumeration Date:2024-09-05
Last Update Date:2024-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF002321-01176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife