Provider Demographics
NPI:1770663346
Name:BARRETT, GLENETT M (NP)
Entity Type:Individual
Prefix:
First Name:GLENETT
Middle Name:M
Last Name:BARRETT
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 6002
Mailing Address - Street 2:
Mailing Address - City:URBANA
Mailing Address - State:IL
Mailing Address - Zip Code:61803-6002
Mailing Address - Country:US
Mailing Address - Phone:217-326-8300
Mailing Address - Fax:
Practice Address - Street 1:610 N. LINCOLN AVENUE
Practice Address - Street 2:
Practice Address - City:URBANA
Practice Address - State:IL
Practice Address - Zip Code:61801
Practice Address - Country:US
Practice Address - Phone:217-383-6555
Practice Address - Fax:217-383-7069
Is Sole Proprietor?:No
Enumeration Date:2006-10-17
Last Update Date:2012-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209005258363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL0533210001Medicare NSC
Q27560Medicare UPIN
ILK12017Medicare PIN
IL6447860005Medicare NSC
ILIL3270309Medicare PIN
ILQ27560Medicare UPIN