Active NPI
Gloria Ann Ennenbach, RN
- Child & Adolescent Psychiatric/Mental Health Registered Nurse
- Freeport, IL
National Provider Identifier
1225544901
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Child & Adolescent Psychiatric/Mental Health Registered Nurse
- License
- 041-332750
- Practice address
- 701 W Lamm Rd
Freeport, IL 61032-9630 - Phone
- (815) 233-6162
- Fax
- (815) 233-6167
- NPI assigned
- Dec 18, 2017
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Child & Adolescent Psychiatric/Mental Health Registered Nurse | 163WP0807X | 041-332750 | IL | Primary |
Addresses
Primary practice location
701 W Lamm Rd
Freeport, IL 61032-9630
Mailing address
701 W Lamm Rd
Freeport, IL 61032-9630
Phone (815) 233-6162
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Registered Nurse
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 041-332750 | IL | MD | Child & Adolescent Psychiatric/Mental Health Registered Nurse |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1513555200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1513555200000",
"number": "1225544901",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "701 W LAMM RD",
"city": "FREEPORT",
"state": "IL",
"postal_code": "610329630",
"telephone_number": "815-233-6162",
"fax_number": "815-233-6167"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "701 W LAMM RD",
"city": "FREEPORT",
"state": "IL",
"postal_code": "610329630",
"telephone_number": "815-233-6162",
"fax_number": "815-233-6167"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ENNENBACH",
"first_name": "GLORIA",
"middle_name": "ANN",
"name_prefix": "Mrs.",
"credential": "RN",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2017-12-18",
"last_updated": "2017-12-18",
"status": "A"
},
"taxonomies": [
{
"code": "163WP0807X",
"taxonomy_group": "",
"desc": "Registered Nurse, Psychiatric/Mental Health, Child & Adolescent",
"state": "IL",
"license": "041-332750",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Freeport, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 18, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.