Healthcare Provider Details

I. General information

NPI: 1659295459
Provider Name (Legal Business Name): KATHRYN GLAYBO RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/05/2026
Last Update Date: 08/05/2026
Certification Date: 08/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1639 W HUBBARD ST
CHICAGO IL
60622-6353
US

IV. Provider business mailing address

10N840 OXFORD LN
ELGIN IL
60124-6748
US

V. Phone/Fax

Practice location:
  • Phone: 773-500-9444
  • Fax:
Mailing address:
  • Phone: 630-935-0210
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number041487042
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: