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General NPI Number Information
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NPI Number | 1164105664
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Entity Type | Individual
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Provider Name | GLENN BAUTISTA APN
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Gender | Male
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Dates
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Enumeration Date | 08/10/2023
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Last Update Date | 03/21/2024
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Provider Practice Location Address
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Address Line | 804 E WOODFIELD RD
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City | SCHAUMBURG
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State | IL
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Zip | 60173-4776
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Country | US
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Telephone | 847-605-0030
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Fax | 847-637-0737
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Provider Business Mailing Address
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Address Line | 1585 BARRINGTON RD STE 501
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City | HOFFMAN ESTATES
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State | IL
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Zip | 60169-5020
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Country | US
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Telephone | 847-490-8900
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Fax | 847-490-8999
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 209028005
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License Number State | IL
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