Provider Demographics
NPI:1417427170
Name:GONZALES, ALICIA LYNN (CPM)
Entity Type:Individual
Prefix:
First Name:ALICIA
Middle Name:LYNN
Last Name:GONZALES
Suffix:
Gender:F
Credentials:CPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10180 SE WAVERLY CT APT 47
Mailing Address - Street 2:
Mailing Address - City:MILWAUKIE
Mailing Address - State:OR
Mailing Address - Zip Code:97222-3416
Mailing Address - Country:US
Mailing Address - Phone:406-781-7579
Mailing Address - Fax:
Practice Address - Street 1:10180 SE WAVERLY CT APT 47
Practice Address - Street 2:
Practice Address - City:MILWAUKIE
Practice Address - State:OR
Practice Address - Zip Code:97222-3416
Practice Address - Country:US
Practice Address - Phone:406-781-7579
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-26
Last Update Date:2018-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula