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General NPI Number Information
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NPI Number | 1700990983
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Entity Type | Individual
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Provider Name | KELLY RAE GLENN-SNYDER N.P.
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Gender | Female
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Dates
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Enumeration Date | 08/18/2006
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Last Update Date | 06/24/2025
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Provider Practice Location Address
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Address Line | 19432 KYLEMORE LN
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City | MOKENA
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State | IL
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Zip | 60448-8003
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Country | US
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Telephone | 708-479-6132
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Fax |
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Provider Business Mailing Address
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Address Line | 19432 KYLEMORE LN
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City | MOKENA
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State | IL
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Zip | 60448-8003
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Country | US
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Telephone | 708-479-6132
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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 | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 041266672
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 041266672
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License Number State | IL
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Taxonomy #3
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 209000688
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License Number State | IL
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