MEDICARE: ANNETTE FRUSHOUR FNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	209.010934	IL

General Provider Information

NPI Number	:	1558792036
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANNETTE FRUSHOUR FNP

Provider Business Mailing Address
First Line	:	1640 WILLOW CIRCLE DR
Second Line	:
City	:	CREST HILL
State	:	IL
Zip	:	60403-0959
Country	:	US
Telephone Number	:	815-741-2525
Fax Number	:	815-741-2522

Provider Business Practice Location Address
First Line	:	1640 WILLOW CIRCLE DR
Second Line	:
City	:	CREST HILL
State	:	IL
Zip	:	60403-0959
Country	:	US
Telephone Number	:	815-741-2525
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/09/2013
Last Update Date	:	05/31/2016

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