Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LG0600X | Nurse Practitioner - Gerontology | 209.020974 | IL |
N | 363LP2300X | Nurse Practitioner - Primary Care | 209.020974 | IL |
NPI | 1043832785 |
---|---|
Provider Name | Dr. Melanie Glander |
First Address | Homewood, IL 60430-3332 |
Second Address | Homewood, IL 60430-3332 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 16/05/2020 |
Last Update Date | 16/05/2020 |