Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363L00000X | Nurse Practitioner | 71001963A | IN |
N | 363LW0102X | Nurse Practitioner - Women's Health | 71001963A | IN |
NPI | 1073548731 |
---|---|
Provider Name | Yolanda Y Gonzalez |
First Address | Lafayette, IN 47903-4699 |
Second Address | Lafayette, IN 47905-8635 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/07/2006 |
Last Update Date | 14/12/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
200529640 | (05) | IN |
71001963A | STATE LICENSE (01) | IN |