Basic Information
| Provider Information | |||||||||
| NPI: | 1689078875 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | FETTER | ||||||||
| FirstName: | ANNE MARIE | ||||||||
| MiddleName: | MORSE | ||||||||
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| Credential: | APN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4201 WINFIELD RD | ||||||||
| Address2: | CENTRALIZED SERVICES, CREDENTIALING 4TH FL | ||||||||
| City: | WARRENVILLE | ||||||||
| State: | IL | ||||||||
| PostalCode: | 60555 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6306463388 | ||||||||
| FaxNumber: | 3312212357 | ||||||||
| Practice Location | |||||||||
| Address1: | 1331 W 75TH ST STE 201 | ||||||||
| Address2: | |||||||||
| City: | NAPERVILLE | ||||||||
| State: | IL | ||||||||
| PostalCode: | 605409311 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6305277205 | ||||||||
| FaxNumber: | 6305277139 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/16/2014 | ||||||||
| LastUpdateDate: | 02/28/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 02/28/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163W00000X | 041354703 | IL | N | Nursing Service Providers | Registered Nurse | 363LF0000X | F0614938 | IL | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.