EDWANA DENISE FULLER (NPI# 1760090765) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1760090765 |
| Entity Type | Individual |
| Full Name | EDWANA DENISE FULLER |
| Credential | RN |
| Practice Address |
5319 S Indiana Ave Apt 1 Chicago IL 60615-4712 |
| Practice Telephone | 7732992777 |
| Mailing Telephone | 7732992777 |
| Enumeration Date | 2020-07-16 |
| Last Update Date | 2020-07-16 |
| Gender Code | F |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 163WM0705X |
Registered Nurse Specialization: Medical-Surgical |
28258565A | IN | Nursing Service Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| IN | LICENSE NUMBER | 28258565A | 01 |
| Street Address |
5319 S INDIANA AVE APT 1 |
| City | CHICAGO |
| State | IL |
| Zip Code | 60615-4712 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1578170221 | Cook County | Technician, Other | 430 East 51st Pl, Chicago, IL 60615 | 2020-09-28 |
| 1700498326 | Connie Frances Davis | Massage Therapist | 5481 S. Cornell, Chicago, IL 60615 | 2020-08-17 |
| 1134781974 | Lifestyle Rejuvenation Medical Group Pllc | Chiropractor | 1740 E 55th Street, Chicago, IL 60615 | 2019-07-02 |
| 1275007767 | Michelle Alyse Costello | Social Worker | 1225 E 53rd St, Suite 606, Chicago, IL 60615 | 2019-01-17 |
| 1194207522 | Cindy Louise Lys | Social Worker | 1525 E 53rd Street Suite 516-4, Chicago, IL 60615 | 2018-09-01 |
| 1861983660 | Pranusha Pinna | Student in an Organized Health Care Education/Training Program | 1850 W. Harrison St., Chicago, IL 60615 | 2018-05-29 |
| 1528577632 | Jonah Waseberg | Counselor | 1100 E.55th St, Chicago, IL 60615 | 2017-09-21 |
| 1710404496 | Tawann Jackson | Psychologist | 360 Blair Lane, Door 13, Bolingbrook, IL 60615 | 2017-08-24 |
| 1194259069 | Molly Kachale Netter | Nurse Practitioner | 1554 E 55th St., Chicago, IL 60615 | 2017-04-17 |
| 1205387990 | Kirk Remon Riddle | Counselor | 1525 E. 53rd Street, Suite 425, Chicago, IL 60615 | 2016-10-18 |
| Find all providers in zip 60615 | ||||
| Taxonomy Code | 163WM0705X |
| Grouping | Nursing Service Providers |
| Classification | Registered Nurse |
| Specialization | Medical-Surgical |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1881239168 | Amy Bachman | Registered Nurse | 840 S Wood St Ste 435ecsb, Chicago, IL 60612-4325 | 2019-11-11 |
| 1669967543 | Shashanna Heard | Registered Nurse | 1301 E 71st Pl Apt 1n, Chicago, IL 60619-1440 | 2018-06-25 |
| 1871007930 | Chequaleis Sargent | Registered Nurse | 2031 N Harlem Ave, Chicago, IL 60707-3280 | 2017-11-28 |
| 1336667070 | Tatanisha Funches | Registered Nurse | 125 S Wacker Dr Ste 475, Chicago, IL 60606-4438 | 2017-09-01 |
| 1306238076 | Patricia A. Hines | Registered Nurse | 1507 E. 53rd St. #815, Chicago, IL 60615-4573 | 2015-03-04 |
| 1982215620 | Jennifer Risner | Registered Nurse | 5841 S Maryland Ave, Chicago, IL 60637-1443 | 2020-08-16 |
| 1750909396 | Savannah Leigh Paul | Registered Nurse | 2233 W Division St, Chicago, IL 60622-8151 | 2020-07-09 |
| 1649829623 | Delicia Elnora Elaine Holiday | Registered Nurse | 140 N Ashland Ave, Chicago, IL 60607-1802 | 2019-09-11 |
| 1811547847 | Margaret Louise Morris | Registered Nurse | 140 N Ashland Ave, Chicago, IL 60607-1802 | 2019-09-11 |
| 1255869145 | Elizabeth Unverricht | Registered Nurse | 222 S Riverside Plz, Chicago, IL 60606-5808 | 2017-05-23 |
| Find all providers in CHICAGO | ||||
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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.