Provider Demographics
NPI:1114316213
Name:GONZALEZ, RENEE JEAN (NURSING LPN)
Entity Type:Individual
Prefix:
First Name:RENEE
Middle Name:JEAN
Last Name:GONZALEZ
Suffix:
Gender:F
Credentials:NURSING LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1034 LOGAN AVE
Mailing Address - Street 2:
Mailing Address - City:SHEBOYGAN
Mailing Address - State:WI
Mailing Address - Zip Code:53083-4853
Mailing Address - Country:US
Mailing Address - Phone:920-918-2708
Mailing Address - Fax:
Practice Address - Street 1:1034 LOGAN AVE
Practice Address - Street 2:
Practice Address - City:SHEBOYGAN
Practice Address - State:WI
Practice Address - Zip Code:53083-4853
Practice Address - Country:US
Practice Address - Phone:920-918-2708
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-13
Last Update Date:2015-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI318898-31164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse