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Individual

MRS. TINA GAYLE CANADA

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
RN BSN

Contact information

Practice address
1000 W HARLEM AVE, MONMOUTH, IL 61462-1007
(309) 734-1424
Mailing address
1493 90TH ST, MONMOUTH, IL 61462-8815

Taxonomy

Speciality
Code
Description
License number
State
163WD0400X
Diabetes Educator Registered Nurse
Primary
041-218084
IL

Other

Enumeration date
06/18/2017
Last updated
06/18/2017
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