Provider Demographics
NPI:1053089532
Name:GLAB, DIANA M (CRNA)
Entity type:Individual
Prefix:MS
First Name:DIANA
Middle Name:M
Last Name:GLAB
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:625 CLAYTON LN
Mailing Address - Street 2:
Mailing Address - City:DES PLAINES
Mailing Address - State:IL
Mailing Address - Zip Code:60016-1029
Mailing Address - Country:US
Mailing Address - Phone:773-600-1972
Mailing Address - Fax:
Practice Address - Street 1:647 METROPOLITAN WAY UNIT 312
Practice Address - Street 2:
Practice Address - City:DES PLAINES
Practice Address - State:IL
Practice Address - Zip Code:60016-4636
Practice Address - Country:US
Practice Address - Phone:773-600-1972
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-31
Last Update Date:2024-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209028001367500000X
IL041.443058163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163W00000XNursing Service ProvidersRegistered Nurse