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General NPI Number Information
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NPI Number | 1124805189
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Entity Type | Individual
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Provider Name | GLENN AGAPE EDILLOR MONTERO MSN, ARN, PMHNP-BC
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Gender | Female
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Dates
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Enumeration Date | 09/13/2023
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Last Update Date | 09/15/2025
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Provider Practice Location Address
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Address Line | 141 MARKET PL STE 100
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City | FAIRVIEW HEIGHTS
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State | IL
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Zip | 62208-2089
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Country | US
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Telephone | 618-398-4226
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Fax |
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Provider Business Mailing Address
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Address Line | 27 OAK KNOLL PL
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City | BELLEVILLE
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State | IL
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Zip | 62223-1880
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Country | US
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Telephone | 815-919-0054
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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 | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 2023062070
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License Number State | MO
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Taxonomy #2
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 209028943
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License Number State | IL
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