Provider Demographics
NPI:1255506135
Name:GONZALES, CASEY ANN (LICENSED MIDWIFE)
Entity Type:Individual
Prefix:
First Name:CASEY
Middle Name:ANN
Last Name:GONZALES
Suffix:
Gender:F
Credentials:LICENSED MIDWIFE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:130 PIERSON LN
Mailing Address - Street 2:
Mailing Address - City:MARION
Mailing Address - State:TX
Mailing Address - Zip Code:78124-1604
Mailing Address - Country:US
Mailing Address - Phone:210-566-5185
Mailing Address - Fax:
Practice Address - Street 1:130 PIERSON LN
Practice Address - Street 2:
Practice Address - City:MARION
Practice Address - State:TX
Practice Address - Zip Code:78124-1604
Practice Address - Country:US
Practice Address - Phone:210-566-5185
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-23
Last Update Date:2008-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX05019176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX05019OtherLICENSED MIDWIFE