Doctor Name: | SARA LYNN GONZALEZ |
NPI Number: | 1083996763 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | APN |
License Number: | 71003712A |
Business Practice Address: | 3777 Frontage Rd Michigan City, IN - 463607695 |
Business Phone Number: | 2198782663 |
Business Fax Number: | 2198782670 |
Mailing Address: | Po Box 1690, LA PORTE |
State: | IN |
Postal Code: | 463521690 |
Phone Number: | 2193262312 |
Fax Number: | 2193262584 |
NPI Enumeration Date: | 09/19/2011 |
NPI Last Update Date: | 04/21/2014 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363LF0000X |
License Number: | 71003712A |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | IN |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Nurse Practitioner |
Taxonomy Specialization: | Family |
Taxonomy Definition: |