Doctor Name: | MRS. MICHELLE LYNN GONZALES |
NPI Number: | 1295710929 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | WHCNP, MSN, RNC |
License Number: | 614476 |
Business Practice Address: | 142 Hart St 82nd Mdos/sgobo Sheppard Afb, TX - 763113428 |
Business Phone Number: | 9406764250 |
Business Fax Number: | 9406761952 |
Mailing Address: | 996 Coulter Dr, BURKBURNETT |
State: | TX |
Postal Code: | 763542930 |
Phone Number: | 9405692213 |
Fax Number: | 9406761952 |
NPI Enumeration Date: | 12/15/2005 |
NPI Last Update Date: | 11/26/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363LW0102X |
License Number: | 614476 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | TX |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Nurse Practitioner |
Taxonomy Specialization: | Women's Health |
Taxonomy Definition: |