Provider Demographics
NPI:1558800474
Name:GONSALVES, FRANK J (LPN)
Entity Type:Individual
Prefix:
First Name:FRANK
Middle Name:J
Last Name:GONSALVES
Suffix:
Gender:M
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1670 DEER CREEK DR
Mailing Address - Street 2:SUITE 8
Mailing Address - City:XENIA
Mailing Address - State:OH
Mailing Address - Zip Code:45385-8047
Mailing Address - Country:US
Mailing Address - Phone:937-241-3604
Mailing Address - Fax:
Practice Address - Street 1:1670 DEER CREEK DR
Practice Address - Street 2:SUITE 8
Practice Address - City:XENIA
Practice Address - State:OH
Practice Address - Zip Code:45385-8047
Practice Address - Country:US
Practice Address - Phone:937-241-3604
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-13
Last Update Date:2017-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH130033164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse