Provider Demographics
NPI:1487154340
Name:GONZALEZ, CHARMAN LAURA
Entity type:Individual
Prefix:
First Name:CHARMAN
Middle Name:LAURA
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 1:1900 AVENUE Q
Mailing Address - Street 2:
Mailing Address - City:SNYDER
Mailing Address - State:TX
Mailing Address - Zip Code:79549-1753
Mailing Address - Country:US
Mailing Address - Phone:210-381-0491
Mailing Address - Fax:
Practice Address - Street 1:2104 41ST ST
Practice Address - Street 2:
Practice Address - City:SNYDER
Practice Address - State:TX
Practice Address - Zip Code:79549-6051
Practice Address - Country:US
Practice Address - Phone:210-381-0491
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-02-17
Last Update Date:2018-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX645243163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse