Provider Demographics
NPI:1225144033
Name:CANALEY, GLORIA L (APN)
Entity Type:Individual
Prefix:
First Name:GLORIA
Middle Name:L
Last Name:CANALEY
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:GLORIA
Other - Middle Name:L
Other - Last Name:MCLAUGHLIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APN
Mailing Address - Street 1:109 CALIFORNIA ST
Mailing Address - Street 2:
Mailing Address - City:CARTERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62918-1923
Mailing Address - Country:US
Mailing Address - Phone:618-985-8221
Mailing Address - Fax:
Practice Address - Street 1:7 S HOSPITAL DR
Practice Address - Street 2:
Practice Address - City:MURPHYSBORO
Practice Address - State:IL
Practice Address - Zip Code:62966-3333
Practice Address - Country:US
Practice Address - Phone:618-687-3418
Practice Address - Fax:618-684-2748
Is Sole Proprietor?:No
Enumeration Date:2006-08-22
Last Update Date:2013-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209003263363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL209003263OtherSTATE LICENSE NUMBER
IL370966854002Medicaid
ILCF3444OtherMEDICARE RR
IL083050OtherHEALTH ALLIANCE
IL370966854005Medicaid
IL370966854005Medicaid
IL640701Medicare Oscar/Certification
IL141848Medicare Oscar/Certification