1689078875 NPI number — ANNE MARIE MORSE FETTER APN

Table of content: ANNE MARIE MORSE FETTER APN (NPI 1689078875)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1689078875 NPI number — ANNE MARIE MORSE FETTER APN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
FETTER
Provider First Name:
ANNE MARIE
Provider Middle Name:
MORSE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
APN
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1689078875
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/28/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4201 WINFIELD RD
Provider Second Line Business Mailing Address:
CENTRALIZED SERVICES, CREDENTIALING 4TH FL
Provider Business Mailing Address City Name:
WARRENVILLE
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60555
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
630-646-3388
Provider Business Mailing Address Fax Number:
331-221-2357

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1331 W 75TH ST STE 201
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NAPERVILLE
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60540-9311
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
630-527-7205
Provider Business Practice Location Address Fax Number:
630-527-7139
Provider Enumeration Date:
10/16/2014

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 163W00000X , with the licence number:  041354703 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363LF0000X , with the licence number: F0614938 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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