Basic Information
| Provider Information | |||||||||
| NPI: | 1497299226 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HOOLEY | ||||||||
| FirstName: | GAYLE | ||||||||
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| Credential: | LPN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 61268 DEER LN | ||||||||
| Address2: | |||||||||
| City: | NEW LONDON | ||||||||
| State: | MO | ||||||||
| PostalCode: | 634594609 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5737956849 | ||||||||
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| Practice Location | |||||||||
| Address1: | 141 COMMUNICATION DR | ||||||||
| Address2: | |||||||||
| City: | HANNIBAL | ||||||||
| State: | MO | ||||||||
| PostalCode: | 634013670 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5736031460 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 12/13/2016 | ||||||||
| LastUpdateDate: | 12/13/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 164W00000X | 053854 | MO | Y | Nursing Service Providers | Licensed Practical Nurse | 164W00000X | 043.088452 | IL | N | Nursing Service Providers | Licensed Practical Nurse |
No ID Information.