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General NPI Number Information
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NPI Number | 1053089318
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Entity Type | Individual
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Provider Name | SAVANNAH ROSE GLAZER
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Gender | Female
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Dates
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Enumeration Date | 09/01/2021
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Last Update Date | 04/20/2022
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Provider Practice Location Address
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Address Line | 1675 DEMPSTER ST
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City | PARK RIDGE
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State | IL
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Zip | 60068-1110
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Country | US
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Telephone | 201-410-1640
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Fax |
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Provider Business Mailing Address
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Address Line | 1930 W POTOMAC AVE
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City | CHICAGO
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State | IL
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Zip | 60622-3149
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Country | US
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Telephone | 201-410-1640
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0200X
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Taxonomy Name | Pediatric Nurse Practitioner
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License Number | 209022345
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License Number State | IL
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