Provider Demographics
NPI:1306189568
Name:VICENTE, EVA MARIA GONI (RN)
Entity Type:Individual
Prefix:MRS
First Name:EVA MARIA
Middle Name:GONI
Last Name:VICENTE
Suffix:
Gender:F
Credentials:RN
Other - Prefix:MRS
Other - First Name:EVA MARIA
Other - Middle Name:GONI
Other - Last Name:VICENTE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RN
Mailing Address - Street 1:246 E CHESTER ST
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:NY
Mailing Address - Zip Code:11561-2203
Mailing Address - Country:US
Mailing Address - Phone:516-225-3970
Mailing Address - Fax:
Practice Address - Street 1:246 E CHESTER ST
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:NY
Practice Address - Zip Code:11561-2203
Practice Address - Country:US
Practice Address - Phone:516-225-3970
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-05
Last Update Date:2013-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY660424-1163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse