Provider Demographics
NPI:1447606777
Name:FUST, CORINNE MARIE (CNA)
Entity Type:Individual
Prefix:
First Name:CORINNE
Middle Name:MARIE
Last Name:FUST
Suffix:
Gender:F
Credentials:CNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9711 ILLINOIS ST
Mailing Address - Street 2:
Mailing Address - City:HEBRON
Mailing Address - State:IL
Mailing Address - Zip Code:60034-8891
Mailing Address - Country:US
Mailing Address - Phone:815-759-7122
Mailing Address - Fax:
Practice Address - Street 1:4001 W DAYTON ST
Practice Address - Street 2:
Practice Address - City:MCHENRY
Practice Address - State:IL
Practice Address - Zip Code:60050-8377
Practice Address - Country:US
Practice Address - Phone:815-759-7122
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-05-05
Last Update Date:2016-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide