Fuller, Mary

Fuller, Mary is an individual health care provider with primary practice located at 110 N Burr Blvd , Kewanee IL 61443-2214. She recently has 3 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Public Health & General Preventive Medicine, Physician Assistants & Advanced Practice Nursing Providers / Primary Care, Physician Assistants & Advanced Practice Nursing Providers / Nurse Practitioner. Physician Assistants & Advanced Practice Nursing Providers / Nurse Practitioner is her primary health care specialty. Fuller, Mary can be contacted via phone (309) 852-0197.

Contact Information

Primary practice address
110 N Burr Blvd Kewanee IL 61443-2214
Phone: (309) 852-0197
Fax: (309) 854-5575
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Public Health & General Preventive Medicine 2083P0901X 209021513 Illinois
Physician Assistants & Advanced Practice Nursing Providers / Primary Care 363LP2300X 209021513 Illinois
Physician Assistants & Advanced Practice Nursing Providers / Nurse Practitioner 363L00000X 209021513 Illinois

Profile Details

NPI number 1497364053
LBN Legal business name Fuller, Mary
Credentials DNP
Entity Individual
Sole proprietor 1 No
Enumeration date Jul 29th, 2020
Last updated Aug 4th, 2020 - about 6 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1497364053 NPPES
Illinois MEDICAID 366006568001

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