Individual
MS. SHAWNDA FULLER-ALWES
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
AUDIOLOGIST
Contact information
Practice address
611 W PARK ST, URBANA, IL 61801-2500
(217) 383-4375
(217) 326-2336
Mailing address
PO BOX 6002, URBANA, IL 61803-6002
(217) 326-8630
(217) 344-8047
Taxonomy
Speciality
Code
Description
License number
State
231H00000X
Audiologist
Primary
147000955
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
113326
HEALTHLINK PROV ID
—
01
—
203
BLUE CROSS PROV ID
IL
01
—
4117
HAMP PROVIDER ID
IL
01
—
7216
PERSONALCARE PROV ID
—
Enumeration date
04/18/2007
Last updated
08/08/2013
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