Provider Demographics
NPI:1275075665
Name:UNIVERSITY OF CHICAGO MEDICAL CENTER
Entity Type:Organization
Organization Name:UNIVERSITY OF CHICAGO MEDICAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ACUTE CARE NURSE PRACTITIONER
Authorized Official - Prefix:
Authorized Official - First Name:ANNA
Authorized Official - Middle Name:C
Authorized Official - Last Name:FULLER
Authorized Official - Suffix:
Authorized Official - Credentials:APN
Authorized Official - Phone:505-450-9185
Mailing Address - Street 1:1529 S STATE ST
Mailing Address - Street 2:APT. 4L
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60605-3011
Mailing Address - Country:US
Mailing Address - Phone:505-450-9185
Mailing Address - Fax:
Practice Address - Street 1:5841 S MARYLAND AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60637-1447
Practice Address - Country:US
Practice Address - Phone:773-702-1000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-11-16
Last Update Date:2016-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209014987282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital