Provider Demographics
NPI:1518089713
Name:GONZALEZ, ALICIA MARIA (MSN, RN, CS)
Entity Type:Individual
Prefix:MS
First Name:ALICIA
Middle Name:MARIA
Last Name:GONZALEZ
Suffix:
Gender:F
Credentials:MSN, RN, CS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 CRUTCHFIELD ST
Mailing Address - Street 2:SUITE C
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27704-2771
Mailing Address - Country:US
Mailing Address - Phone:919-471-6501
Mailing Address - Fax:919-471-2211
Practice Address - Street 1:400 CRUTCHFIELD ST
Practice Address - Street 2:SUITE C
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27704-2771
Practice Address - Country:US
Practice Address - Phone:919-471-6501
Practice Address - Fax:919-471-2211
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-06
Last Update Date:2011-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC069496364SP0809X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SP0809XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health, Adult