Provider Demographics
NPI:1154867307
Name:GONCALVES, MARIA ISABEL (NP)
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:ISABEL
Last Name:GONCALVES
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
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Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 249
Mailing Address - Street 2:E3
Mailing Address - City:YADKINVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27055-0249
Mailing Address - Country:US
Mailing Address - Phone:336-679-4963
Mailing Address - Fax:336-679-2549
Practice Address - Street 1:55 N MAIN ST
Practice Address - Street 2:
Practice Address - City:FREEPORT
Practice Address - State:NY
Practice Address - Zip Code:11520-2243
Practice Address - Country:US
Practice Address - Phone:516-377-8014
Practice Address - Fax:516-377-8017
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-12
Last Update Date:2018-09-21
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY340347363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty