MEDICARE: ROSEMARY HINES FULLER

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	390200000X	Student in an Organized Health Care Education/Training Program
2	208000000X	Pediatrics Physician	036.160680	IL

General Provider Information

NPI Number	:	1730571563
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROSEMARY HINES FULLER

Provider Business Mailing Address
First Line	:	46 GREEN BAY RD
Second Line	:
City	:	WINNETKA
State	:	IL
Zip	:	60093-4006
Country	:	US
Telephone Number	:	630-418-1905
Fax Number	:

Provider Business Practice Location Address
First Line	:	46 GREEN BAY RD
Second Line	:
City	:	WINNETKA
State	:	IL
Zip	:	60093-4006
Country	:	US
Telephone Number	:	630-418-1905
Fax Number	:

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

Provider Enumeration Date	:	03/03/2015
Last Update Date	:	03/05/2025

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Directions to “ ROSEMARY HINES FULLER ” Practice Location

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