CHARLES FULLER (NPI# 1063518934) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1063518934 |
| Entity Type | Individual |
| Full Name | CHARLES FULLER |
| Credential | CRNA |
| Practice Address |
612 S Sibley Ave Litchfield MN 55355-3340 |
| Mailing Address |
400 E 10th St Waconia MN 55387-4552 |
| Practice Telephone | 3206933242 |
| Mailing Telephone | 9524429770 |
| Mailing Fax Number | 9524423630 |
| Enumeration Date | 2006-09-16 |
| Last Update Date | 2008-04-29 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 367500000X | Nurse Anesthetist, Certified Registered | R064879-2 | MN | Physician Assistants & Advanced Practice Nursing Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| MN | BLUE CROSS OF MN | 767S7AN | 01 |
| MN | 445542800 | 05 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1952845240 | Charles Robert Fuller II | Counselor | 10802 Fm 2621, Brenham, TX 77833-0164 | 2016-12-06 |
| 1780680439 | Charles W Fuller | Emergency Medicine | 1933 Pine St, Ste B, Abilene, TX 79601-2431 | 2005-06-27 |
| 1376091819 | Charles Fuller | Counselor | 702 Sunset Dr, Ontario, OR 97914-3121 | 2016-09-13 |
| 1487986972 | Charles E Fuller | Counselor | 189 Professional Ct Se, Suite 105, Calhoun, GA 30701-7053 | 2010-02-08 |
| Street Address |
612 S SIBLEY AVE |
| City | LITCHFIELD |
| State | MN |
| Zip Code | 55355-3340 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1700892262 | Steven Arthur Norman | Physical Therapist | 612 S Sibley Ave, Litchfield, MN 55355-3340 | 2006-08-01 |
| 1447859517 | Karissa L Lozinski | Nurse Practitioner | 612 S Sibley Ave, Litchfield, MN 55355-3340 | 2020-10-20 |
| 1093312159 | Jammie Kay Klobes | Nurse Practitioner | 612 S Sibley Ave, Litchfield, MN 55355-3340 | 2020-10-02 |
| 1083221816 | County of Meeker | Clinic/Center | 612 S Sibley Ave, Litchfield, MN 55355-3340 | 2020-09-25 |
| 1023669819 | Taylor Elizabeth Flegel | Physical Therapist | 612 S Sibley Ave, Litchfield, MN 55355-3340 | 2019-09-24 |
| 1962067793 | Doug P Briggman | Registered Nurse | 612 S Sibley Ave, Litchfield, MN 55355-3340 | 2019-05-07 |
| 1922567668 | Tera L Bredeson | Nurse Anesthetist, Certified Registered | 612 S Sibley Ave, Litchfield, MN 55355-3340 | 2019-03-12 |
| 1306336094 | Emily Kubesh | Physical Therapist | 612 S Sibley Ave, Litchfield, MN 55355-3340 | 2018-05-17 |
| 1225528912 | Mackenzie Hoffman | Occupational Therapist | 612 S Sibley Ave, Litchfield, MN 55355-3340 | 2018-05-17 |
| 1922513100 | Jill M David Jensen | Nurse Practitioner | 612 S Sibley Ave, Litchfield, MN 55355-3340 | 2017-12-09 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1073112983 | Katie Sue Fairchild | Pharmacist | 2301 E Frontage Rd, Litchfield, MN 55355 | 2020-10-21 |
| 1316419377 | Meeker-mcleod-sibley Community Health Services | Preventive Medicine | 114 North Holbombe Ave, Litchfield, MN 55355 | 2018-12-31 |
| 1275009086 | Joyce Lin Knieff | Acupuncturist | 703 N Holcombe Ave, Litchfield, MN 55355 | 2018-10-18 |
| 1154861839 | Cornerstone Care | Home Health | 23766 570th Ave, Litchfield, MN 55355 | 2017-03-01 |
| 1427420744 | Pathways Therapeutic Services, LLC | Social Worker | 621 Sibley Ave South, Litchfield, MN 55355 | 2015-10-26 |
| 1982002663 | Emily Brookshaw | Physical Therapist | 612 South Sibley Avenue, Litchfield, MN 55355 | 2014-12-12 |
| 1275882771 | Patricia Judith Finnegan-baker | Pharmacist | 59563 300th St, Litchfield, MN 55355 | 2012-08-30 |
| 1972832301 | Tracy Madsen | Registered Nurse | 114 N. Holcombe, Litchfield, MN 55355 | 2009-12-14 |
| 1144495391 | David Edward Schlack | Psychologist | 1326 East Ripley Street, Litchfield, MN 55355 | 2008-04-29 |
| 1033391099 | St. Cloud Hospital | Clinic/Center | 520 Hwy 12 East, Suite 6, Litchfield, MN 55355 | 2007-12-03 |
| Find all providers in zip 55355 | ||||
| Taxonomy Code | 367500000X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Nurse Anesthetist, Certified Registered |
| (1) A licensed registered nurse with advanced specialty education in anesthesia who, in collaboration with appropriate health care professionals, provides preoperative, intraoperative, and postoperative care to patients and assists in management and resuscitation of critical patients in intensive care, coronary care, and emergency situations. Nurse anesthetists are certified following successful completion of credentials and state licensure review and a national examination directed by the Council on Certification of Nurse Anesthetists. (2) A registered nurse who is qualified by special training to administer anesthesia in collaboration with a physician or dentist and who can assist in the care of patients who are in critical condition. |
| Notes: Sources: (1) Council on Certification of Nurse Anesthetists, Park Ridge, IL, and Rhea, Ott, and Shafritz, The Facts On File Dictionary of Health Care Management, New York: Facts On File Publications, 1988. (2) Lexikon: Dictionary of Health Care Terms, Organizations and Acronyms for the Era of Reform, The Joint Commission on Accreditation of Healthcare Organizations, Oakbrook Terrace, Illinois: 1994, p. 548. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1689770745 | Mary Jospehine Bernheim | Nurse Anesthetist, Certified Registered | 12 Norfolk Rd, Litchfield, CT 06759-2537 | 2006-09-16 |
| 1922567668 | Tera L Bredeson | Nurse Anesthetist, Certified Registered | 612 S Sibley Ave, Litchfield, MN 55355-3340 | 2019-03-12 |
| 1083151351 | County of Meeker | Nurse Anesthetist, Certified Registered | 612 S Sibley Ave, Litchfield, MN 55355-3340 | 2017-01-25 |
| 1104216944 | Wallace Barrett Jr. | Nurse Anesthetist, Certified Registered | 1215 Franciscan Dr, Litchfield, IL 62056-1778 | 2015-02-02 |
| 1477844439 | Thad Peter Larson | Nurse Anesthetist, Certified Registered | 612 S Sibley Ave, Litchfield, MN 55355-3340 | 2011-04-26 |
| 1720226442 | Patti S Durbin | Nurse Anesthetist, Certified Registered | 1215 Franciscan Drive, Anesthesia Dept, Litchfield, IL 62056 | 2009-02-03 |
| 1336361922 | Amsol Anesthetists of Litchfield Il | Nurse Anesthetist, Certified Registered | 1215 Franciscan Drive, Litchfield, IL 62056-1778 | 2007-05-03 |
| 1235230210 | John P. Jurkanin | Nurse Anesthetist, Certified Registered | 1215 Franciscan Dr, Litchfield, IL 62056-1778 | 2006-09-25 |
| 1992806970 | Steven R. Wright | Nurse Anesthetist, Certified Registered | 1215 Franciscan Dr, Litchfield, IL 62056-1778 | 2006-09-25 |
| 1255438552 | County of Meeker | Nurse Anesthetist, Certified Registered | 612 S Sibley Ave, Litchfield, MN 55355-3340 | 2006-09-20 |
| Find all providers in LITCHFIELD | ||||
| City | LITCHFIELD |
| Zip Code | 55355 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.