Provider Demographics
NPI:1497427348
Name:GONZALEZ, AMANDA R (RN, BSN)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:R
Last Name:GONZALEZ
Suffix:
Gender:F
Credentials:RN, BSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:113 RONGE ST N
Mailing Address - Street 2:# 194
Mailing Address - City:ROY
Mailing Address - State:WA
Mailing Address - Zip Code:98580
Mailing Address - Country:US
Mailing Address - Phone:971-218-0414
Mailing Address - Fax:
Practice Address - Street 1:113 RONGE ST N
Practice Address - Street 2:#194
Practice Address - City:ROY
Practice Address - State:WA
Practice Address - Zip Code:98580-9858
Practice Address - Country:US
Practice Address - Phone:971-218-0414
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-29
Last Update Date:2021-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA61180410163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse