Healthcare Provider Details

I. General information

NPI: 1689078875
Provider Name (Legal Business Name): ANNE MARIE M. FETTER APN-CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/16/2014
Last Update Date: 05/11/2026
Certification Date: 05/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1331 W 75TH ST STE 201
NAPERVILLE IL
60540-9311
US

IV. Provider business mailing address

4201 WINFIELD RD CENTRALIZED SERVICES, CREDENTIALING 4TH FL
WARRENVILLE IL
60555
US

V. Phone/Fax

Practice location:
  • Phone: 630-527-7205
  • Fax: 630-527-7139
Mailing address:
  • Phone: 630-646-3388
  • Fax: 331-221-2357

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number209011820
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number209011820
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: