Provider Demographics
NPI:1366538480
Name:IRELAND, GLORIA ANN (RN MSN CNP CERTIFIED)
Entity type:Individual
Prefix:MRS
First Name:GLORIA
Middle Name:ANN
Last Name:IRELAND
Suffix:
Gender:F
Credentials:RN MSN CNP CERTIFIED
Other - Prefix:
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Mailing Address - Street 1:6345 GENAW ROAD
Mailing Address - Street 2:
Mailing Address - City:ALGONAC
Mailing Address - State:MI
Mailing Address - Zip Code:48001
Mailing Address - Country:US
Mailing Address - Phone:810-794-0003
Mailing Address - Fax:810-794-0003
Practice Address - Street 1:22101 MOROSS ROAD PB 1
Practice Address - Street 2:SUITE 332 ST JOHN HOSPITAL & MEDICAL CENTER
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48236
Practice Address - Country:US
Practice Address - Phone:810-794-0003
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-05
Last Update Date:2012-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704136816363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner