Provider Demographics
NPI:1417769878
Name:GONZALEZ, KATHARINE ANN
Entity type:Individual
Prefix:
First Name:KATHARINE
Middle Name:ANN
Last Name:GONZALEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:KATHARINE
Other - Middle Name:ANN
Other - Last Name:GOESS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:286 BRETTONWOODS DR
Mailing Address - Street 2:
Mailing Address - City:CORAM
Mailing Address - State:NY
Mailing Address - Zip Code:11727-3686
Mailing Address - Country:US
Mailing Address - Phone:631-576-6412
Mailing Address - Fax:
Practice Address - Street 1:400 CROOKED HILL RD
Practice Address - Street 2:
Practice Address - City:BRENTWOOD
Practice Address - State:NY
Practice Address - Zip Code:11717-1039
Practice Address - Country:US
Practice Address - Phone:631-231-3232
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-01-23
Last Update Date:2025-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY332396-01164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse