Healthcare Provider Details

I. General information

NPI: 1396133971
Provider Name (Legal Business Name): LYNETTE GLANTON RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/05/2015
Last Update Date: 02/22/2023
Certification Date: 02/22/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10537 S ROBERTS RD
PALOS HILLS IL
60465-1933
US

IV. Provider business mailing address

9930 CONSTITUTION CT
ORLAND PARK IL
60462-4559
US

V. Phone/Fax

Practice location:
  • Phone: 708-974-2300
  • Fax: 708-974-2498
Mailing address:
  • Phone: 708-968-5694
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number041.502273
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: