Provider Demographics
NPI:1083350409
Name:GONZALEZ, THERESA MANRIQUEZ (LPN)
Entity Type:Individual
Prefix:MISS
First Name:THERESA
Middle Name:MANRIQUEZ
Last Name:GONZALEZ
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:553 MCHENRY RD
Mailing Address - Street 2:
Mailing Address - City:WHEELING
Mailing Address - State:IL
Mailing Address - Zip Code:60090-9237
Mailing Address - Country:US
Mailing Address - Phone:847-808-6215
Mailing Address - Fax:847-808-6210
Practice Address - Street 1:553 MCHENRY RD
Practice Address - Street 2:
Practice Address - City:WHEELING
Practice Address - State:IL
Practice Address - Zip Code:60090-9237
Practice Address - Country:US
Practice Address - Phone:847-808-6215
Practice Address - Fax:847-808-6210
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-09
Last Update Date:2022-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL043.114162164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse