Provider Demographics
NPI:1033433214
Name:EMBRY, GLENDA M (CNM)
Entity Type:Individual
Prefix:
First Name:GLENDA
Middle Name:M
Last Name:EMBRY
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:39 CEDAR GATE CIR
Mailing Address - Street 2:
Mailing Address - City:SUGAR GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60554-4205
Mailing Address - Country:US
Mailing Address - Phone:630-567-1075
Mailing Address - Fax:630-466-3835
Practice Address - Street 1:1435 N RANDALL RD STE 304
Practice Address - Street 2:
Practice Address - City:ELGIN
Practice Address - State:IL
Practice Address - Zip Code:60123-2304
Practice Address - Country:US
Practice Address - Phone:847-697-7722
Practice Address - Fax:847-697-7896
Is Sole Proprietor?:No
Enumeration Date:2010-03-17
Last Update Date:2012-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209002101367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife