Individual
MRS. GLORIA ANN ENNENBACH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RN
Contact information
Practice address
701 W LAMM RD, FREEPORT, IL 61032-9630
(815) 233-6162
(815) 233-6167
Mailing address
701 W LAMM RD, FREEPORT, IL 61032-9630
(815) 233-6162
(815) 233-6167
Taxonomy
Speciality
Code
Description
License number
State
163WP0807X
Child & Adolescent Psychiatric/Mental Health Registered Nurse
Primary
041-332750
IL
Other
Enumeration date
12/18/2017
Last updated
12/18/2017
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