Provider Demographics
NPI:1255853529
Name:GONZALEZ, ELENA (CNP)
Entity Type:Individual
Prefix:
First Name:ELENA
Middle Name:
Last Name:GONZALEZ
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:ELENA
Other - Middle Name:
Other - Last Name:CREWS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2460 FAIRMOUNT BLVD STE 215
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44106-3125
Mailing Address - Country:US
Mailing Address - Phone:877-426-0426
Mailing Address - Fax:
Practice Address - Street 1:2460 FAIRMOUNT BLVD STE 215
Practice Address - Street 2:
Practice Address - City:CLEVELAND HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44106-3125
Practice Address - Country:US
Practice Address - Phone:877-426-0426
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-07-08
Last Update Date:2023-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPRN.CNP.021107363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily