Provider Demographics
NPI:1104204064
Name:GONZALES, FRANCISCA L (LPN)
Entity Type:Individual
Prefix:
First Name:FRANCISCA
Middle Name:L
Last Name:GONZALES
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:PO BOX 810
Mailing Address - Street 2:
Mailing Address - City:SELLS
Mailing Address - State:AZ
Mailing Address - Zip Code:85634-0810
Mailing Address - Country:US
Mailing Address - Phone:520-383-6200
Mailing Address - Fax:520-383-8806
Practice Address - Street 1:ARIZONA STATE HIGHWAY 86 MILE POST 112
Practice Address - Street 2:
Practice Address - City:SELLS
Practice Address - State:AZ
Practice Address - Zip Code:85634-0810
Practice Address - Country:US
Practice Address - Phone:520-383-6200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-12
Last Update Date:2015-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLP045245164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse