Provider Demographics
NPI:1124805189
Name:MONTERO, GLENN AGAPE EDILLOR (MSN, ARN, PMHNP-BC)
Entity type:Individual
Prefix:
First Name:GLENN AGAPE
Middle Name:EDILLOR
Last Name:MONTERO
Suffix:
Gender:F
Credentials:MSN, ARN, PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27 OAK KNOLL PL
Mailing Address - Street 2:
Mailing Address - City:BELLEVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62223-1880
Mailing Address - Country:US
Mailing Address - Phone:815-919-0054
Mailing Address - Fax:
Practice Address - Street 1:141 MARKET PL STE 100
Practice Address - Street 2:
Practice Address - City:FAIRVIEW HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:62208-2089
Practice Address - Country:US
Practice Address - Phone:618-398-4226
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-13
Last Update Date:2025-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2023062070363LP0808X
IL209028943363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health