MS. LAURA MARIE FULLERTON (NPI# 1356406144) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1356406144 |
| Entity Type | Individual |
| Full Name | MS. LAURA MARIE FULLERTON |
| Other Name | LAURA GREEN |
| Credential | APN |
| Practice Address |
2321 N Wisconsin Ave Peoria IL 61603 |
| Mailing Address |
2214 N University St Peoria IL 61604-3221 |
| Practice Telephone | 3096807600 |
| Practice Fax Number | 3096814681 |
| Mailing Telephone | 3096807600 |
| Mailing Fax Number | 3096818443 |
| Enumeration Date | 2006-12-22 |
| Last Update Date | 2018-07-25 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363LF0000X |
Nurse Practitioner Specialization: Family |
209-001938 | IL | Physician Assistants & Advanced Practice Nursing Providers |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1275705337 | Laura 'ginny' Fullerton | Psychologist | 6300 West Loop S, Ste 420, Bellaire, TX 77401-2900 | 2008-03-28 |
| Street Address |
2321 N WISCONSIN AVE |
| City | PEORIA |
| State | IL |
| Zip Code | 61603 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1992757322 | Christine L Tharenos | Family Medicine | 2321 N Wisconsin Ave, Peoria, IL 61603-5613 | 2006-05-16 |
| 1083142038 | Samantha Elizabeth Martin | Advanced Practice Midwife | 2321 N Wisconsin Ave, Peoria, IL 61603-5613 | 2017-06-02 |
| 1740725837 | Angela Marie Miller | Nurse Practitioner | 2321 N Wisconsin Ave, Peoria, IL 61603-5613 | 2016-12-27 |
| 1235505108 | Bethany Joy Winfrey Ferguson | Nurse Practitioner | 2321 N Wisconsin Ave, Peoria, IL 61603-5613 | 2015-08-14 |
| 1932587797 | Elizabeth Gabel | Family Medicine | 2321 N Wisconsin Ave, Peoria, IL 61603-5613 | 2015-05-13 |
| 1588075048 | Mary Jennifer Sue Meister | Social Worker | 2321 N Wisconsin Ave, Peoria, IL 61603-5613 | 2014-05-17 |
| 1972932317 | Meghan Jean Khaiser | Physician Assistant | 2321 N Wisconsin Ave, Peoria, IL 61603-5613 | 2013-11-06 |
| 1811326317 | Carolyn Ann Calhoun | Advanced Practice Midwife | 2321 N Wisconsin Ave, Peoria, IL 61603-5613 | 2013-11-05 |
| 1467658443 | Heartland Community Health Clinic | Clinic/Center | 2321 N Wisconsin Ave, Peoria, IL 61603-5613 | 2007-06-26 |
| 1639215312 | Kwabena A Boateng | Obstetrics & Gynecology | 2321 N Wisconsin Ave, Peoria, IL 61603-5613 | 2007-01-29 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1598362980 | Courtney Klein | Nurse Practitioner | 1306 N. Berkley Ave, Peoria, IL 61603 | 2020-10-08 |
| 1114588217 | Kong Xing Wang | Dentist | 320 East Armstrong Ave, Peoria, IL 61603 | 2019-06-28 |
| 1073015319 | Sara Kristine Rosenbery | Nurse Practitioner | 515 Ne Glen Oak Ave Ste 202, Peoria, IL 61603 | 2018-03-02 |
| 1861860058 | Jennifer Michelle Kelsey | Clinical Nurse Specialist | 420 Ne Glen Oak Avenue, Suite 401, Peoria, IL 61603 | 2015-09-04 |
| 1467859793 | Bonnie Lansing | Counselor | 617 N Gendale Avenue, Behavioral Health Adult Program, Peoria, IL 61603 | 2014-12-02 |
| 1639597172 | Jael K. Mahasi | Counselor | 1800 Ne Perry Avenue, Peoria, IL 61603 | 2014-04-02 |
| 1992054829 | Justin S Ferragut | Radiology | 530 Northeast Glen Oak Avenue, Peoria, IL 61603 | 2012-09-06 |
| 1780952994 | Syed Muhammad Tayyab | Internal Medicine | 828 Ne Glen Oak Ave Apt No208a, Peoria, IL 61603 | 2011-12-02 |
| 1528389079 | St. Francis Medical Center | General Acute Care Hospital | 530 N E Glen Oak Ave, Peoria, IL 61603 | 2010-06-18 |
| 1780810648 | Children's Home Association of Illinois | Voluntary or Charitable | 400 E. Frye, Peoria, IL 61603 | 2009-06-05 |
| Find all providers in zip 61603 | ||||
| Taxonomy Code | 363LF0000X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Nurse Practitioner |
| Specialization | Family |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1881295541 | Britney Julia Durst | Nurse Practitioner | 5905 N Prospect Rd, Peoria, IL 61614-4311 | 2020-11-07 |
| 1598362980 | Courtney Klein | Nurse Practitioner | 1306 N. Berkley Ave, Peoria, IL 61603 | 2020-10-08 |
| 1699390039 | Steven Joel Schlink | Nurse Practitioner | 12920 W Roy Rogers Rd, Peoria, AZ 85383-5334 | 2020-06-11 |
| 1457986929 | Chanelle Christine Maclin | Nurse Practitioner | 504 E Kansas St, Peoria, IL 61603-2554 | 2020-03-05 |
| 1225677495 | Michelle Chacon | Nurse Practitioner | 23201 N 87th Dr, Peoria, AZ 85383-1860 | 2020-01-05 |
| 1689218042 | Patricia Nwakaego Ayemoba | Nurse Practitioner | 16018 N 74th Dr, Peoria, AZ 85382-1810 | 2019-10-29 |
| 1144877267 | Eunice Wright | Nurse Practitioner | 26826 N 85th Dr, Peoria, AZ 85383-3624 | 2019-08-22 |
| 1861057507 | Shawnee Renee Fudurich | Nurse Practitioner | 10230 W Happy Valley Pkwy Ste 100, Peoria, AZ 85383-4255 | 2019-05-08 |
| 1265096895 | Razel Espiritu Hernandez | Nurse Practitioner | 25435 N 115th Ave, Peoria, AZ 85383-9789 | 2019-04-29 |
| 1619435310 | Jennifer Gayle Ries-clark | Nurse Practitioner | 8009 W Salter Dr, Peoria, AZ 85382-4440 | 2019-03-12 |
| Find all providers in PEORIA | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.