Provider Demographics
NPI:1114990066
Name:CANTOR, GLORIA F (APRN CNS)
Entity Type:Individual
Prefix:
First Name:GLORIA
Middle Name:F
Last Name:CANTOR
Suffix:
Gender:F
Credentials:APRN CNS
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:7066 STILLWATER BLVD N
Mailing Address - Street 2:
Mailing Address - City:OAKDALE
Mailing Address - State:MN
Mailing Address - Zip Code:55128-3937
Mailing Address - Country:US
Mailing Address - Phone:651-777-5222
Mailing Address - Fax:651-251-5111
Practice Address - Street 1:7066 STILLWATER BLVD N
Practice Address - Street 2:
Practice Address - City:OAKDALE
Practice Address - State:MN
Practice Address - Zip Code:55128-3937
Practice Address - Country:US
Practice Address - Phone:651-777-5222
Practice Address - Fax:651-251-5111
Is Sole Proprietor?:No
Enumeration Date:2006-02-10
Last Update Date:2019-04-05
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MN0994103364S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364S00000XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN413956900Medicaid
MN413956900Medicaid
MN890000602Medicare PIN