Individual
MS. CAROL SUE FAIRLESS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RN
Contact information
Practice address
408 E VINE ST, VIENNA, IL 62995-1612
(618) 658-2611
(618) 658-2501
Mailing address
303 COUNTRY VLG, VIENNA, IL 62995-1643
(618) 658-9295
Taxonomy
Speciality
Code
Description
License number
State
163WC0400X
Case Management Registered Nurse
—
IL
163WP0808X
Psychiatric/Mental Health Registered Nurse
Primary
—
IL
Other
Enumeration date
08/17/2006
Last updated
09/11/2025
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