MRS. MARY FULLER (NPI# 1497364053) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1497364053 |
| Entity Type | Individual |
| Full Name | MRS. MARY FULLER |
| Credential | DNP |
| Practice Address |
110 N Burr Blvd Kewanee IL 61443-2214 |
| Practice Telephone | 3098520197 |
| Practice Fax Number | 3098545575 |
| Mailing Telephone | 3098520197 |
| Mailing Fax Number | 3098545575 |
| Enumeration Date | 2020-07-29 |
| Last Update Date | 2020-08-04 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 2083P0901X |
Preventive Medicine Specialization: Public Health & General Preventive Medicine |
209021513 | IL | Allopathic & Osteopathic Physicians |
| Y | 363L00000X | Nurse Practitioner | 209021513 | IL | Physician Assistants & Advanced Practice Nursing Providers |
| N | 363LP2300X |
Nurse Practitioner Specialization: Primary Care |
209021513 | IL | Physician Assistants & Advanced Practice Nursing Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| IL | 366006568001 | 05 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1740751015 | Mary Fuller | Home Health Aide | 3043 N 29th St., Milwaukee, WI 53209 | 2018-12-16 |
| 1295052009 | Mary Elizabeth Fuller | Physical Therapist | 300 N Virginia St, Port Lavaca, TX 77979-3449 | 2010-05-03 |
| 1013113133 | Mary Ann Fuller | Dietitian, Registered | 415 Springtree Rd, Lake Dallas, TX 75065-2392 | 2007-06-25 |
| 1902938525 | Mary E Fuller | Marriage & Family Therapist | 835 Sorrelwood Ct, Westlake Village, CA 91361-1840 | 2007-03-09 |
| 1538130984 | Mary Margaret Fuller | Counselor | 40347 Us Highway 19 N Ste 103, Tarpon Springs, FL 34689-4841 | 2006-02-01 |
| 1639723240 | Mary Cassandra Fuller | Nurse Practitioner | 4499 Medical Dr, San Antonio, TX 78229-3735 | 2019-07-31 |
| 1326503707 | Mary Alise Fuller | Technician | 3030 30th St Se, Washington, DC 20020-1674 | 2019-02-09 |
| 1245775428 | Mary N. Fuller | Nurse Practitioner | 109 Daniel Dr, Danville, KY 40422 | 2016-12-27 |
| 1285034058 | Mary Fuller | Registered Nurse | 495 Congress Ave, New Haven, CT 06519-1312 | 2014-08-29 |
| 1689913774 | Mary Ellen Fuller | Occupational Therapist | 1 Freedom Way, Active Duty Rehab Unit (27), Augusta, GA 30904-6258 | 2013-02-08 |
| Street Address |
110 N BURR BLVD |
| City | KEWANEE |
| State | IL |
| Zip Code | 61443-2214 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1851394829 | County of Henry | Clinic/Center | 110 N Burr Blvd, Kewanee, IL 61443-2214 | 2005-05-24 |
| 1265066625 | County of Henry | Clinic/Center | 110 N Burr Blvd, Kewanee, IL 61443-2214 | 2020-02-25 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1013453471 | Kelly Neirynck | Licensed Practical Nurse | 420 E Mill St, Kewanee, IL 61443 | 2017-01-10 |
| 1275760456 | Daniel P. Congreve | Surgery | 1051 West South Street, Kewanee, IL 61443 | 2009-06-16 |
| 1215188487 | Petersen Health Care, Inc | Nursing Facility/Intermediate Care Facility | 144 Jounior Ave., Kewanee, IL 61443 | 2008-10-07 |
| 1114112265 | Carla Greby | Internal Medicine | 2021 Kentville Rd, Iyc Kewanee, Kewanee, IL 61443 | 2007-09-12 |
| 1740362979 | Petersen Health Systems, Inc | Assisted Living Facility | 808 Sunset Drive, Kewanee, IL 61443 | 2006-10-19 |
| 1902993652 | Kerry Howard Head | Optometrist | 730 Tenney Street, Kewanee, IL 61443 | 2006-10-06 |
| 1205927464 | Gordon M Pointer | Chiropractor | 627 East 2nd St, Kewanee, IL 61443 | 2006-09-27 |
| 1699887729 | Stephen L Rider | Dentist | 125 West South Street, Suite #10, Kewanee, IL 61443 | 2006-08-31 |
| 1336153121 | Kelli E Rashid | Occupational Therapist | 125 South Street, Suite B, Kewanee, IL 61443 | 2006-07-28 |
| 1740247394 | Jon A Debord | Physical Therapist | 125 South St, Suite B, Kewanne, IL 61443 | 2006-04-27 |
| Find all providers in zip 61443 | ||||
| Taxonomy Code | 363L00000X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Nurse Practitioner |
| (1) A registered nurse provider with a graduate degree in nursing prepared for advanced practice involving independent and interdependent decision making and direct accountability for clinical judgment across the health care continuum or in a certified specialty. (2) A registered nurse who has completed additional training beyond basic nursing education and who provides primary health care services in accordance with state nurse practice laws or statutes. Tasks performed by nurse practitioners vary with practice requirements mandated by geographic, political, economic, and social factors. Nurse practitioner specialists include, but are not limited to, family nurse practitioners, gerontological nurse practitioners, pediatric nurse practitioners, obstetric-gynecologic nurse practitioners, and school nurse practitioners. |
| Notes: Source: (1) American Nurses’ Association, American Nurses Credentialing Center, 1996 Certification Catalogue. (2) ) Lexikon: Dictionary of Health Care Terms, Organizations and Acronyms for the Era of Reform, The Joint Commission on Accreditation of Healthcare Organizations, Oakbrook Terrace, Illinois: 1994, p. 549. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1881224376 | Jaclyn Alice Heiser Brandmeyer | Nurse Practitioner | 259 Beach St S, Kewanee, IL 61443-3459 | 2020-01-23 |
| 1730139106 | Jennifer Brokaw | Nurse Practitioner | 1258w South St 2, Kewanee, IL 61443-8300 | 2006-05-10 |
| 1356989917 | Leslie N Bowser | Nurse Practitioner | 1051 W South St, Kewanee, IL 61443-8354 | 2019-12-13 |
| 1215592183 | Amy Bronaugh | Nurse Practitioner | 4424 Us Highway 34, Kewanee, IL 61443-8319 | 2019-05-07 |
| 1942678016 | Josefina Foreman | Nurse Practitioner | 4424 Us Highway 34, Kewanee, IL 61443-8319 | 2015-09-08 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1619578523 | Kaitlin Lawson Kalnitz | Nurse Practitioner | 745 Mcclintock Dr Ste 360, Burr Ridge, IL 60527-0875 | 2020-11-06 |
| 1841890290 | Maria Malanych | Nurse Practitioner | 5731 Rosinweed Ln, Naperville, IL 60564-1635 | 2020-10-27 |
| 1639778160 | Roxanna Lee Gunnels | Nurse Practitioner | 1 Bronze Pointe Plaza Suite 1a, Swansea, IL 62226 | 2020-10-26 |
| 1295334811 | Mary Farley | Nurse Practitioner | 7308 Northwood Dr, Wonder Lake, IL 60097-8606 | 2020-10-24 |
| 1164021168 | Stephanie Schuster | Nurse Practitioner | 2665 Prairieview Ln N, Aurora, IL 60502-6343 | 2020-10-21 |
| 1316546641 | Vanessa K Bajaj | Nurse Practitioner | 1123 N Claremont Dr, Palatine, IL 60074-4002 | 2020-10-19 |
| 1003414442 | Gachugu Medical Clinic | Nurse Practitioner | 1 E Ferguson Ave, Wood River, IL 62095-1903 | 2020-10-16 |
| 1477151272 | Yolanda K Bradford | Nurse Practitioner | 2700 S California Ave, Chicago, IL 60608-5108 | 2020-10-14 |
| 1265030019 | Andrea Mclean | Nurse Practitioner | 2500 W Reynolds St # 205, Pontiac, IL 61764-9774 | 2020-10-14 |
| 1558968628 | Timothy Nenoff | Nurse Practitioner | 24722 Lincolnway St, Plainfield, IL 60544-2412 | 2020-10-02 |
| Find all providers with the same taxonomy | ||||
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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.