Provider Demographics
NPI:1114322591
Name:GONZALES, ANGELICA CHAN (ND, RN)
Entity Type:Individual
Prefix:
First Name:ANGELICA
Middle Name:CHAN
Last Name:GONZALES
Suffix:
Gender:F
Credentials:ND, RN
Other - Prefix:
Other - First Name:ANGELICA
Other - Middle Name:
Other - Last Name:GONZALEZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:63235 BRITTA ST
Mailing Address - Street 2:
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97703-7064
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:20370 POE SHOLES DR
Practice Address - Street 2:
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97703-7938
Practice Address - Country:US
Practice Address - Phone:541-728-3319
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-10-28
Last Update Date:2023-12-29
Deactivation Date:2018-01-04
Deactivation Code:
Reactivation Date:2023-12-08
Provider Licenses
StateLicense IDTaxonomies
OR2078175F00000X
OR201907006RN163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No175F00000XOther Service ProvidersNaturopath