Healthcare Provider Details

I. General information

NPI: 1649686916
Provider Name (Legal Business Name): GLENDA CORDERO FRAGANTE NP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: GLENDA LIMOS CORDERO

II. Dates (important events)

Enumeration Date: 07/08/2014
Last Update Date: 05/05/2021
Certification Date: 05/05/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4201 W MEDICAL CENTER DR
MCHENRY IL
60050-8409
US

IV. Provider business mailing address

4201 W MEDICAL CENTER DR
MCHENRY IL
60050-8409
US

V. Phone/Fax

Practice location:
  • Phone: 815-759-4323
  • Fax: 815-759-4948
Mailing address:
  • Phone: 815-759-4323
  • Fax: 815-759-4948

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number209-011677
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number041297029
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: