Provider Demographics
NPI:1780942326
Name:FIFER, ANNETTE (CRT/RCP)
Entity type:Individual
Prefix:MS
First Name:ANNETTE
Middle Name:
Last Name:FIFER
Suffix:
Gender:F
Credentials:CRT/RCP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2316 ASHLAND DR
Mailing Address - Street 2:APT 205C
Mailing Address - City:MORRIS
Mailing Address - State:IL
Mailing Address - Zip Code:60450-0088
Mailing Address - Country:US
Mailing Address - Phone:815-474-4203
Mailing Address - Fax:
Practice Address - Street 1:2316 ASHLAND DR
Practice Address - Street 2:APT 205C
Practice Address - City:MORRIS
Practice Address - State:IL
Practice Address - Zip Code:60450-0088
Practice Address - Country:US
Practice Address - Phone:815-474-4203
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-02
Last Update Date:2012-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL194.005097227800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes227800000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRespiratory Therapist, Certified