Provider Demographics
NPI:1558015420
Name:GOMEZ, ANGELICA (NURSE PRACTITIONER F)
Entity Type:Individual
Prefix:MRS
First Name:ANGELICA
Middle Name:
Last Name:GOMEZ
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER F
Other - Prefix:MS
Other - First Name:ANGELICA
Other - Middle Name:
Other - Last Name:REYES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6127 GREENBAY ROAD-SINUS AND SNORING MD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:KENASHA
Mailing Address - State:WI
Mailing Address - Zip Code:53140
Mailing Address - Country:US
Mailing Address - Phone:262-425-9108
Mailing Address - Fax:262-764-0224
Practice Address - Street 1:6127 GREENBAY ROAD-SINUS AND SNORING MD
Practice Address - Street 2:SUITE 100
Practice Address - City:KENASHA
Practice Address - State:WI
Practice Address - Zip Code:53140
Practice Address - Country:US
Practice Address - Phone:262-425-9108
Practice Address - Fax:262-764-0224
Is Sole Proprietor?:No
Enumeration Date:2022-02-09
Last Update Date:2023-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI319095-31363L00000X
WI11797-33363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner