Provider Demographics
NPI:1073548731
Name:GONZALEZ, YOLANDA Y (RNC NP)
Entity Type:Individual
Prefix:
First Name:YOLANDA
Middle Name:Y
Last Name:GONZALEZ
Suffix:
Gender:F
Credentials:RNC NP
Other - Prefix:
Other - First Name:YOLANDA
Other - Middle Name:Y
Other - Last Name:ZEPEDA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 4699
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:IN
Mailing Address - Zip Code:47903-4699
Mailing Address - Country:US
Mailing Address - Phone:765-449-2732
Mailing Address - Fax:765-446-5317
Practice Address - Street 1:975 MEZZANINE DR
Practice Address - Street 2:SUITE C
Practice Address - City:LAFAYETTE
Practice Address - State:IN
Practice Address - Zip Code:47905-8635
Practice Address - Country:US
Practice Address - Phone:765-807-2780
Practice Address - Fax:765-807-2781
Is Sole Proprietor?:No
Enumeration Date:2006-07-11
Last Update Date:2021-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71001963A363LW0102X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200529640Medicaid
IN71001963AOtherSTATE LICENSE
IN113810PPMedicare PIN