Provider Demographics
NPI:1396981510
Name:GONZALEZ, MERRI ANN
Entity type:Individual
Prefix:MRS
First Name:MERRI ANN
Middle Name:
Last Name:GONZALEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4279 VESELY RD
Mailing Address - Street 2:
Mailing Address - City:SHELL LAKE
Mailing Address - State:WI
Mailing Address - Zip Code:54871-8105
Mailing Address - Country:US
Mailing Address - Phone:715-349-5852
Mailing Address - Fax:
Practice Address - Street 1:4279 VESELY RD
Practice Address - Street 2:
Practice Address - City:SHELL LAKE
Practice Address - State:WI
Practice Address - Zip Code:54871-8105
Practice Address - Country:US
Practice Address - Phone:715-349-5852
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-17
Last Update Date:2008-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI127272-030163W00000X
IL041224244163W00000X
IN28092296A163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse