Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207L00000X | Anesthesiologist | 036116486 | IL |
Y | 207L00000X | Anesthesiologist | ME 99735 | FL |
NPI | 1003018177 |
---|---|
Provider Name | Nancy Gonzalez |
First Address | Fairfax, VA 22033-2921 |
Second Address | Park Ridge, IL 60068 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/06/2007 |
Last Update Date | 20/12/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
036116486 | (05) | IL |