Individual
KELLY RAE GLENN-SNYDER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
N.P.
Contact information
Practice address
19432 KYLEMORE LN, MOKENA, IL 60448-8003
(708) 479-6132
Mailing address
19432 KYLEMORE LN, MOKENA, IL 60448-8003
(708) 479-6132
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
041266672
IL
363LF0000X
Family Nurse Practitioner
041266672
IL
363LF0000X
Family Nurse Practitioner
Primary
209000688
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
IL5686023
MEDICARE PTAN
IL
01
—
P00147725
R/R MEDICARE
—
Enumeration date
08/18/2006
Last updated
06/24/2025
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