Provider Demographics
NPI:1225774805
Name:GONZALES, MARIA VERONICA (NURSE PRACTITIONER)
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:VERONICA
Last Name:GONZALES
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3492 BREWER RD
Mailing Address - Street 2:
Mailing Address - City:DARIEN
Mailing Address - State:IL
Mailing Address - Zip Code:60561-1759
Mailing Address - Country:US
Mailing Address - Phone:917-361-0024
Mailing Address - Fax:
Practice Address - Street 1:206 S NELTNOR BLVD
Practice Address - Street 2:
Practice Address - City:WEST CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60185-2847
Practice Address - Country:US
Practice Address - Phone:773-658-0311
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-07
Last Update Date:2022-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209.021040363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care