Provider Demographics
NPI:1821210287
Name:GLAUBER, WALTER R (NP)
Entity type:Individual
Prefix:
First Name:WALTER
Middle Name:R
Last Name:GLAUBER
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:311 W LINCOLN ST
Mailing Address - Street 2:STE 201
Mailing Address - City:BELLEVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62263-1902
Mailing Address - Country:US
Mailing Address - Phone:618-222-3200
Mailing Address - Fax:618-222-3203
Practice Address - Street 1:311 W LINCOLN ST
Practice Address - Street 2:STE 201
Practice Address - City:BELLEVILLE
Practice Address - State:IL
Practice Address - Zip Code:62263-1902
Practice Address - Country:US
Practice Address - Phone:618-222-3200
Practice Address - Fax:618-222-3203
Is Sole Proprietor?:No
Enumeration Date:2007-05-03
Last Update Date:2014-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO097839163W00000X, 363LF0000X
IL041-201910163W00000X
IL209.001302363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL$$$$$$$$$Medicaid
IL$$$$$$$$$Medicaid