Provider Demographics
NPI:1528784725
Name:GONZALEZ, GONZALO (DNP, APRN, NP-C)
Entity type:Individual
Prefix:DR
First Name:GONZALO
Middle Name:
Last Name:GONZALEZ
Suffix:
Gender:M
Credentials:DNP, APRN, NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:246 SNELLING AVE S UNIT 507
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55105-3594
Mailing Address - Country:US
Mailing Address - Phone:734-255-9639
Mailing Address - Fax:
Practice Address - Street 1:246 SNELLING AVE S UNIT 507
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55105-3594
Practice Address - Country:US
Practice Address - Phone:734-255-9639
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-18
Last Update Date:2022-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI202018805363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner