Provider Demographics
NPI:1417562729
Name:GONZALEZ, BRENDA L (FNP-BC)
Entity type:Individual
Prefix:MRS
First Name:BRENDA
Middle Name:L
Last Name:GONZALEZ
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:210 LINCOLN ST STE 301
Mailing Address - Street 2:
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01605-2529
Mailing Address - Country:US
Mailing Address - Phone:508-926-8029
Mailing Address - Fax:508-213-9017
Practice Address - Street 1:210 LINCOLN ST STE 301
Practice Address - Street 2:
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01605-2529
Practice Address - Country:US
Practice Address - Phone:508-926-8029
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-14
Last Update Date:2024-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN2328089363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily