Provider Demographics
NPI:1558792036
Name:FRUSHOUR, ANNETTE (FNP)
Entity Type:Individual
Prefix:
First Name:ANNETTE
Middle Name:
Last Name:FRUSHOUR
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1640 WILLOW CIRCLE DR
Mailing Address - Street 2:
Mailing Address - City:CREST HILL
Mailing Address - State:IL
Mailing Address - Zip Code:60403-0959
Mailing Address - Country:US
Mailing Address - Phone:815-741-2525
Mailing Address - Fax:815-741-2522
Practice Address - Street 1:1640 WILLOW CIRCLE DR
Practice Address - Street 2:
Practice Address - City:CREST HILL
Practice Address - State:IL
Practice Address - Zip Code:60403-0959
Practice Address - Country:US
Practice Address - Phone:815-741-2525
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-12-09
Last Update Date:2016-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209.010934363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily