Provider Demographics
NPI:1427857382
Name:FULLER, MARY SUSAN (RN)
Entity type:Individual
Prefix:MRS
First Name:MARY
Middle Name:SUSAN
Last Name:FULLER
Suffix:
Gender:
Credentials:RN
Other - Prefix:MRS
Other - First Name:MARY
Other - Middle Name:SUSAN
Other - Last Name:SKELTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:301 N WASHINGTON STREET
Mailing Address - Street 2:SUITE 2470
Mailing Address - City:HERKIMER
Mailing Address - State:NY
Mailing Address - Zip Code:13350
Mailing Address - Country:US
Mailing Address - Phone:315-867-1465
Mailing Address - Fax:315-867-1469
Practice Address - Street 1:301 N WASHINGTON STREET HERKIMER COUNTY MENTAL HEALTH
Practice Address - Street 2:SUITE 2470
Practice Address - City:HERKIMER
Practice Address - State:NY
Practice Address - Zip Code:13350
Practice Address - Country:US
Practice Address - Phone:315-867-1465
Practice Address - Fax:315-867-1469
Is Sole Proprietor?:No
Enumeration Date:2025-03-12
Last Update Date:2025-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY533738-01163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse