Provider Demographics
NPI:1386674745
Name:GONZALEZ, MICHELLE (WHNP)
Entity Type:Individual
Prefix:MS
First Name:MICHELLE
Middle Name:
Last Name:GONZALEZ
Suffix:
Gender:F
Credentials:WHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1515 PAPPAS ST
Mailing Address - Street 2:
Mailing Address - City:LAREDO
Mailing Address - State:TX
Mailing Address - Zip Code:78041-1705
Mailing Address - Country:US
Mailing Address - Phone:956-795-8100
Mailing Address - Fax:956-795-8135
Practice Address - Street 1:1515 PAPPAS ST
Practice Address - Street 2:
Practice Address - City:LAREDO
Practice Address - State:TX
Practice Address - Zip Code:78041-1705
Practice Address - Country:US
Practice Address - Phone:956-795-8100
Practice Address - Fax:956-795-8135
Is Sole Proprietor?:No
Enumeration Date:2006-07-03
Last Update Date:2008-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX58919363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX589719OtherTX LICENCE
TX589719OtherTX LICENCE
TX451960Medicare Oscar/Certification
TX451838Medicare Oscar/Certification
TX8G5240Medicare PIN
TX451962Medicare Oscar/Certification
TX00CH47Medicare Oscar/Certification
TXQ68122Medicare UPIN
TX451841Medicare Oscar/Certification
TX451961Medicare Oscar/Certification