Provider Demographics
NPI:1043576135
Name:GONZALEZ, CARMEN M (RN)
Entity Type:Individual
Prefix:
First Name:CARMEN
Middle Name:M
Last Name:GONZALEZ
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1440 STORY AVE
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10473-4909
Mailing Address - Country:US
Mailing Address - Phone:718-860-5060
Mailing Address - Fax:718-860-5100
Practice Address - Street 1:1440 STORY AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10473-4909
Practice Address - Country:US
Practice Address - Phone:718-860-5060
Practice Address - Fax:718-860-5100
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-03
Last Update Date:2012-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY440104-1163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse