COLLEEN M CANAVAN (NPI# 1205090644) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1205090644 |
| Entity Type | Individual |
| Full Name | COLLEEN M CANAVAN |
| Credential | PA |
| Practice Address |
390 Maple Summit Rd Jerseyville IL 62052-2000 |
| Practice Telephone | 6184982101 |
| Practice Fax Number | 6184988153 |
| Mailing Telephone | 6184982101 |
| Mailing Fax Number | 6184988153 |
| Enumeration Date | 2008-07-15 |
| Last Update Date | 2016-09-21 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363A00000X | Physician Assistant | 085000651 | IL | Physician Assistants & Advanced Practice Nursing Providers |
| Street Address |
390 MAPLE SUMMIT RD |
| City | JERSEYVILLE |
| State | IL |
| Zip Code | 62052-2000 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1326034919 | Srirama S Kurella | Internal Medicine | 390 Maple Summit Rd, Jerseyville, IL 62052-2000 | 2005-09-20 |
| 1700499274 | Carrie H Purdy | Nurse Practitioner | 390 Maple Summit Rd, Illini Bldg, Jerseyville, IL 62052 | 2020-08-25 |
| 1124579099 | Mary Beck | Nurse Practitioner | 390 Maple Summit Rd, Jerseyville, IL 62052 | 2016-10-17 |
| 1811392970 | Jersey Community Hospital | Clinic/Center | 390 Maple Summit Rd, Jerseyville, IL 62052-2000 | 2014-10-30 |
| 1578901930 | Illini Medical Associates, Sc | Durable Medical Equipment & Medical Supplies | 390 Maple Summit Rd, Jerseyville, IL 62052-2000 | 2013-06-07 |
| 1598036071 | Krista E Jenkins | Physician Assistant | 390 Maple Summit Rd, Jerseyville, IL 62052-2000 | 2012-01-16 |
| 1023259967 | Victoria Ann Hargrave | Registered Nurse | 390 Maple Summit Rd, Jerseyville, IL 62052-2000 | 2009-03-22 |
| 1215062914 | Cynthia Barrett | Clinical Nurse Specialist | 390 Maple Summit Rd, Jerseyville, IL 62052-2000 | 2007-02-22 |
| 1053345488 | Deborah Marie Seymour | Nurse Practitioner | 390 Maple Summit Rd, Jerseyville, IL 62052-2000 | 2006-07-10 |
| 1013965698 | Illini Medical Associates Sc | Clinic/Center | 390 Maple Summit Rd, Jerseyville, IL 62052-2000 | 2006-05-05 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1396265666 | Lauren Mccarthy | Podiatrist | 400 Maple Summit Rd Suite 200, Jerseyville, IL 62052 | 2017-06-27 |
| 1851757488 | German Insurance Agency | Local Education Agency (LEA) | 850 S State Street, Jerseyville, IL 62052 | 2016-01-12 |
| 1942584230 | Thomas G Honke | Pharmacist | 705 South State, Walgreens, Jerseyville, IL 62052 | 2011-10-05 |
| 1861786493 | Pain Relief Center | Clinic/Center | 903 South State Street, Jerseyville, IL 62052 | 2011-05-31 |
| 1902058845 | Ronald Lee Schroeder | Obstetrics & Gynecology | 1211 West Carpenter, Jerseyville, IL 62052 | 2008-10-22 |
| 1760696116 | Rebecca Elaine Alexander | Massage Therapist | 1301 S State St, Jerseyville, IL 62052 | 2007-05-09 |
| 1205950540 | Charles C Alexander | Chiropractor | 1301 S State, Jerseyville, IL 62052 | 2007-03-19 |
| 1902816358 | Kirk William Schultz | Chiropractor | 519 South State Street, Jerseyville, IL 62052 | 2006-08-08 |
| 1235119652 | Batool N Vali | Obstetrics & Gynecology | 1702 W. County Road, Jerseyville, IL 62052 | 2006-01-20 |
| 1649270729 | Jersey County Health Department | Public Health or Welfare | 1307 State Highway 109, Jerseyville, IL 62052 | 2005-07-29 |
| Find all providers in zip 62052 | ||||
| Taxonomy Code | 363A00000X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Physician Assistant |
| A physician assistant is a person who has successfully completed an accredited education program for physician assistant, is licensed by the state and is practicing within the scope of that license. Physician assistants are formally trained to perform many of the routine, time-consuming tasks a physician can do. In some states, they may prescribe medications. They take medical histories, perform physical exams, order lab tests and x-rays, and give inoculations. Most states require that they work under the supervision of a physician. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1063010924 | Mckenzie Youngblood | Physician Assistant | 28653 Wren Ln, Jerseyville, IL 62052-6501 | 2020-10-13 |
| 1508258393 | Lindsey Buckles | Physician Assistant | 400 Maple Summit Rd, Jerseyville, IL 62052-2028 | 2015-03-03 |
| 1598036071 | Krista E Jenkins | Physician Assistant | 390 Maple Summit Rd, Jerseyville, IL 62052-2000 | 2012-01-16 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1548877400 | Shawn Milhauser | Physician Assistant | 1014 N Mill St, Pontiac, IL 61764-1332 | 2020-09-25 |
| 1982210654 | Brittany Michelle Weber | Physician Assistant | 525 E Congress Pkwy Ste 200, Crystal Lake, IL 60014-6271 | 2020-09-18 |
| 1003421603 | Logan M Barkley | Physician Assistant | 2560 24th St Ste 201, Rock Island, IL 61201-5390 | 2020-09-10 |
| 1336753342 | Navneet Kaur Bamrah | Physician Assistant | 11316 S Highland Dr, Plainfield, IL 60585-1581 | 2020-09-07 |
| 1306450424 | Annie Mannancheril | Physician Assistant | 9114 Waukegan Rd, Morton Grove, IL 60053-2135 | 2020-09-04 |
| 1508470709 | Bryan Ying Wong | Physician Assistant | 3420 S Morgan St Apt 2e, Chicago, IL 60608-6904 | 2020-09-04 |
| 1386256402 | Emma Schmidt | Physician Assistant | 20 Haverton Ct, Streamwood, IL 60107-1682 | 2020-08-19 |
| 1063024388 | Alyson Dyck | Physician Assistant | 2540 Health Services, Ssb Student Services Building, Normal, IL 61790-2540 | 2020-08-18 |
| 1649882192 | Anna Marie Phillips | Physician Assistant | 5337 Main St, Skokie, IL 60077-2029 | 2020-08-17 |
| 1316557770 | Brian Sautter | Physician Assistant | 1125 Wishing Well Ln, Naperville, IL 60564-8782 | 2020-07-31 |
| Find all providers with the same taxonomy | ||||
| City | JERSEYVILLE |
| Zip Code | 62052 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.