MEDICARE: MRS. DIANE MARIE GLICK APN-CNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LA2100X	Acute Care Nurse Practitioner	209.009618	IL
2	363L00000X	Nurse Practitioner	209009618	IL

General Provider Information

NPI Number	:	1184979544
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. DIANE MARIE GLICK APN-CNP

Provider Business Mailing Address
First Line	:	2650 RIDGE AVE STE 1223
Second Line	:
City	:	EVANSTON
State	:	IL
Zip	:	60201-1700
Country	:	US
Telephone Number	:	847-570-2040
Fax Number	:

Provider Business Practice Location Address
First Line	:	4201 MEDICAL CENTER DRIVE
Second Line	:
City	:	MCHENRY
State	:	IL
Zip	:	60050
Country	:	US
Telephone Number	:	224-520-3434
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/20/2012
Last Update Date	:	04/07/2026

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