Fuller, Edwana Denise
Fuller, Edwana Denise is an sole proprietor health care provider with primary practice located at 5319 S Indiana Ave Apt 1 , Chicago IL 60615-4712. She recently has only one registered license in Nursing Service Providers / Medical-Surgical, which is considered as her primary health care specialty. Fuller, Edwana Denise can be contacted via phone (773) 299-2777.Contact Information
Primary practice address
5319 S Indiana Ave Apt 1
Chicago IL 60615-4712
Phone: (773) 299-2777
Fax:
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Nursing Service Providers / Medical-Surgical | 163WM0705X | 28258565A | Indiana |
Profile Details
| NPI number | 1760090765 |
|---|---|
| LBN Legal business name | Fuller, Edwana Denise |
| Credentials | Registered Nurse (RN) |
| Entity | Individual |
| Sole proprietor 1 | Yes |
| Enumeration date | Jul 16th, 2020 |
| Last updated | Jul 16th, 2020 - about 4 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.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1760090765 | NPPES |
| Indiana | Other | 28258565A | LICENSE NUMBER |
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