Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LC1500X | Nurse Practitioner - Community Health | AP30004017 | WA |
NPI | 1437239928 |
---|---|
Provider Name | Mercedes Gonzalez |
First Address | Moses Lake, WA 98837-1893 |
Second Address | Moses Lake, WA 98837-1893 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/10/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
S43272 | (02) | WA |