MS. CAROL SUE FAIRLESS (NPI# 1619080082) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1619080082 |
| Entity Type | Individual |
| Full Name | MS. CAROL SUE FAIRLESS |
| Credential | RN |
| Practice Address |
408 E Vine St Vienna IL 62995-1612 |
| Mailing Address |
303 Country Vlg Vienna IL 62995-1643 |
| Practice Telephone | 6186582611 |
| Practice Fax Number | 6186582501 |
| Mailing Telephone | 6186589295 |
| Enumeration Date | 2006-08-17 |
| Last Update Date | 2007-07-08 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| X | 163WC0400X |
Registered Nurse Specialization: Case Management |
IL | Nursing Service Providers | |
| X | 163WP0808X |
Registered Nurse Specialization: Psych/Mental Health |
IL | Nursing Service Providers |
| Street Address |
408 E VINE ST |
| City | VIENNA |
| State | IL |
| Zip Code | 62995-1612 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1093188021 | Karen Sue Brown Wright | Counselor | 408 E Vine St, Vienna, IL 62995-1612 | 2015-11-13 |
| 1245606599 | Andrea Aird | Counselor | 408 E Vine St, Vienna, IL 62995-1612 | 2015-08-20 |
| 1417323866 | Sarah Newman | Counselor | 408 E Vine St, Vienna, IL 62995-1612 | 2015-08-19 |
| 1124404124 | Mallory Hartman | Counselor | 408 E Vine St, Vienna, IL 62995-1612 | 2015-08-03 |
| 1528443769 | Amy Johnson | Counselor | 408 E Vine St, Vienna, IL 62995-1612 | 2015-07-29 |
| 1356726707 | Family Counseling Center | Community/Behavioral Health | 408 E Vine St, Same, Vienna, IL 62995-1612 | 2015-07-28 |
| 1801271259 | Family Counseling Center, Inc | Community/Behavioral Health | 408 E Vine St, Vienna, IL 62995-1612 | 2015-07-28 |
| 1215312509 | Marsha Hayes | Counselor | 408 E Vine St, Vienna, IL 62995-1612 | 2015-07-28 |
| 1396120929 | Haley Leach | Counselor | 408 E Vine St, Vienna, IL 62995-1612 | 2015-07-24 |
| 1578958062 | Debra Hayes | Counselor | 408 E Vine St, Vienna, IL 62995-1612 | 2015-04-01 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1538663463 | Gregory M Blakely | Physical Therapist | 811 North 1st Street, Vienna, IL 62995 | 2018-03-23 |
| 1194101196 | Ashley Laws | Counselor | 408 E. Vine, Vienna, IL 62995 | 2015-08-03 |
| 1477981421 | Amanda Endrizzi | Physician Assistant | 803 North 1st Street, Vienna, IL 62995 | 2013-10-29 |
| 1780831453 | Family Counseling Center, Inc. | Community Based Residential Treatment Facility, Mental Illness | 904 Vine Street, Vienna, IL 62995 | 2008-08-25 |
| 1528215290 | Family Counseling Center, Inc. | Clinic/Center | 406 East Vine Street, Vienna, IL 62995 | 2008-08-25 |
| 1770676207 | Martha Jane Crawford | Social Worker | 408 E Vine, Vienna, IL 62995 | 2006-10-02 |
| 1235147216 | Rachel Ann Edmonds | Physical Therapist | 811 N 1st Street, Vienna, IL 62995 | 2006-08-04 |
| 1376572552 | Bode Drug Inc | Pharmacy | 803 and One Half N First St, Vienna, IL 62995 | 2006-07-01 |
| 1578557476 | Roger Franklin High | Chiropractor | 122 N 4th St, Vienna, IL 62995 | 2005-09-07 |
| 1932263332 | Rural Health, Inc. | Clinic/Center | 803 N 1st St, Vienna, IL 62995 | 2006-12-20 |
| Find all providers in zip 62995 | ||||
| Taxonomy Code | 163WC0400X |
| Grouping | Nursing Service Providers |
| Classification | Registered Nurse |
| Specialization | Case Management |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1861011645 | Cheryl D Jones | Registered Nurse | 375th Mdg, 310 W. Losey Street, Scott Afb, IL 62225 | 2020-04-13 |
| 1447898721 | Sophia Bracey | Registered Nurse | 443 Fairway Ct, University Park, IL 60484 | 2019-12-17 |
| 1336704089 | Nkechinyere Uzoma | Registered Nurse | 3709 Culloden St, Flossmoor, IL 60422-4318 | 2019-05-08 |
| 1235601410 | Hannah Dawn Saguin Cimafranca | Registered Nurse | 1900 W Polk St Unit 154, Chicago, IL 60612-3723 | 2018-12-28 |
| 1609347269 | Deborah De La Haye | Registered Nurse | 3523 W 76th St, Chicago, IL 60652-1405 | 2018-12-07 |
| 1336619188 | Sutara M Giles | Registered Nurse | 13933 Laramie Ave Apt 205, Crestwood, IL 60418-1654 | 2018-12-04 |
| 1487124335 | Albeza Veronica Ruiz | Registered Nurse | 2331 199th St, Lynwood, IL 60411-9665 | 2018-12-03 |
| 1407322837 | Lawanda Burnett-berry | Registered Nurse | 1801 W Polk St, Suite 154, Chicago, IL 60612 | 2018-10-24 |
| 1891262226 | Cyndril Bendijo Carreon-palencia | Registered Nurse | 1900 W Polk St Rm 154, Chicago, IL 60612-3723 | 2018-10-24 |
| 1407322316 | Charity Nwaru | Registered Nurse | 1313 Meyer Ct, Homewood, IL 60430-4545 | 2018-10-17 |
| Find all providers with the same taxonomy | ||||
Please comment or provide details below to improve the information on MS. CAROL SUE FAIRLESS.
| 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.