Provider Demographics
NPI:1275106148
Name:GONZALEZ, HALLIE ELIZABETH (CNM)
Entity Type:Individual
Prefix:
First Name:HALLIE
Middle Name:ELIZABETH
Last Name:GONZALEZ
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:HALLIE
Other - Middle Name:ELIZABETH
Other - Last Name:RANEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:301 N CENTER ST
Mailing Address - Street 2:
Mailing Address - City:HARTFORD
Mailing Address - State:MI
Mailing Address - Zip Code:49057-1199
Mailing Address - Country:US
Mailing Address - Phone:269-621-0011
Mailing Address - Fax:269-308-3336
Practice Address - Street 1:301 N CENTER ST
Practice Address - Street 2:
Practice Address - City:HARTFORD
Practice Address - State:MI
Practice Address - Zip Code:49057-1199
Practice Address - Country:US
Practice Address - Phone:269-621-0011
Practice Address - Fax:269-308-3336
Is Sole Proprietor?:No
Enumeration Date:2021-07-20
Last Update Date:2021-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704308081163WW0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WW0101XNursing Service ProvidersRegistered NurseWomen's Health Care, Ambulatory