Healthcare Provider Details

I. General information

NPI: 1821210287
Provider Name (Legal Business Name): WALTER R. GLAUBER NP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/03/2007
Last Update Date: 09/29/2026
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

311 W LINCOLN ST STE 201
BELLEVILLE IL
62263-1902
US

IV. Provider business mailing address

311 W LINCOLN ST STE 201
BELLEVILLE IL
62263-1902
US

V. Phone/Fax

Practice location:
  • Phone: 618-222-3200
  • Fax: 618-222-3203
Mailing address:
  • Phone: 618-222-3200
  • Fax: 618-222-3203

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number097839
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number209.001302
License Number StateIL
# 3
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number097839
License Number StateMO
# 4
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number041-201910
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: