Individual
GLORIA L CANALEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
APN
Contact information
Practice address
7 S HOSPITAL DR, MURPHYSBORO, IL 62966-3333
(618) 687-3418
(618) 684-2748
Mailing address
109 CALIFORNIA ST, CARTERVILLE, IL 62918-1923
(618) 985-8221
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
209003263
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
083050
HEALTH ALLIANCE
IL
01
—
209003263
STATE LICENSE NUMBER
IL
05
—
370966854002
—
IL
05
—
370966854005
—
IL
01
—
CF3444
MEDICARE RR
IL
Enumeration date
08/22/2006
Last updated
11/27/2013
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