Healthcare Provider Details

I. General information

NPI: 1003735481
Provider Name (Legal Business Name): GLOWEN JANICA GOROSPE MEI MSN, APRN, ACNPC-AG
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/10/2026
Last Update Date: 07/11/2026
Certification Date: 07/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3134 N CLARK ST
CHICAGO IL
60657-4414
US

IV. Provider business mailing address

3134 N CLARK ST
CHICAGO IL
60657-4414
US

V. Phone/Fax

Practice location:
  • Phone: 312-766-4949
  • Fax:
Mailing address:
  • Phone: 312-766-4949
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number209.036018
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: