Provider Demographics
NPI:1235408428
Name:GONZALEZ, CHEYANNE ELAINE (LPN)
Entity Type:Individual
Prefix:MISS
First Name:CHEYANNE
Middle Name:ELAINE
Last Name:GONZALEZ
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 1:52 SPRING ST
Mailing Address - Street 2:
Mailing Address - City:MONTICELLO
Mailing Address - State:NY
Mailing Address - Zip Code:12701-2253
Mailing Address - Country:US
Mailing Address - Phone:845-794-5319
Mailing Address - Fax:
Practice Address - Street 1:252 MAIN ST
Practice Address - Street 2:
Practice Address - City:GOSHEN
Practice Address - State:NY
Practice Address - Zip Code:10924-2178
Practice Address - Country:US
Practice Address - Phone:845-294-1513
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-19
Last Update Date:2011-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY280427-1251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health