Anthony Demetrius Fuller | Amityville, NY • PECOS Search

Anthony Demetrius Fuller

Licensed Practical Nurse

Nursing Service Providers

44 The Blvd, Amityville, NY 11701-1433

PECOS Enrollment

Based on the most recent information from CMS, provider Anthony Demetrius Fuller does not have current enrollment records in PECOS.

Part B
Medicare Part B
Not Enrolled
HHA
Home Health Agency
Not Enrolled
DME
Durable Medical Equipment
Not Enrolled
PMD
Power Mobility Device
Not Enrolled

CMS last updated its PECOS records yesterday at 9:43 AM.

Profile Details

Provider ID
1073636494
Provider Type
Individual
Full Name
Fuller, Anthony Demetrius
Title
Mr.
Credential
L.P.N

Gender
Male
Sole Proprietor
Yes
Enumeration Date
4/9/2007
Last Updated
7/8/2007

Contact Information

Practice Location

44 The Blvd, Amityville, NY 11701-1433

Unlisted Fax

Mailing Location

44 The Blvd, Amityville, NY 11701-1433

Unlisted Fax

Provider Taxonomies

Code	Description	License
Code 164W00000X Primary	Description Licensed Practical Nurse Nursing Service Providers	License 228275 New York