Provider Demographics
NPI:1518432194
Name:GOMEZ, ANNETTE (NP)
Entity Type:Individual
Prefix:
First Name:ANNETTE
Middle Name:
Last Name:GOMEZ
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5717 MEMORIAL RD
Mailing Address - Street 2:
Mailing Address - City:GERMANSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:18053-2205
Mailing Address - Country:US
Mailing Address - Phone:610-216-1449
Mailing Address - Fax:
Practice Address - Street 1:2024 LEHIGH ST STE 100
Practice Address - Street 2:
Practice Address - City:ALLENTOWN
Practice Address - State:PA
Practice Address - Zip Code:18103-4938
Practice Address - Country:US
Practice Address - Phone:610-402-7800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-10
Last Update Date:2018-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP019171363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology