Provider Demographics
NPI:1427795228
Name:FULLER, ANNETTE M (PMPNP-BC, MSN, CNL)
Entity type:Individual
Prefix:MS
First Name:ANNETTE
Middle Name:M
Last Name:FULLER
Suffix:
Gender:
Credentials:PMPNP-BC, MSN, CNL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1655 N ARLINGTON HEIGHTS RD STE 200W
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON HEIGHTS
Mailing Address - State:IL
Mailing Address - Zip Code:60004-3977
Mailing Address - Country:US
Mailing Address - Phone:773-263-0903
Mailing Address - Fax:
Practice Address - Street 1:1655 N ARLINGTON HEIGHTS RD STE 200
Practice Address - Street 2:
Practice Address - City:ARLINGTON HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:60004-3982
Practice Address - Country:US
Practice Address - Phone:847-342-2020
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-13
Last Update Date:2025-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209027763363LP0808X
MARN-TEMP15236163WP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health