Provider Demographics
NPI:1558890350
Name:GONZALEZ, DIONNE
Entity Type:Individual
Prefix:
First Name:DIONNE
Middle Name:
Last Name:GONZALEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19871 W FREMONT RD
Mailing Address - Street 2:
Mailing Address - City:BUCKEYE
Mailing Address - State:AZ
Mailing Address - Zip Code:85326-9512
Mailing Address - Country:US
Mailing Address - Phone:623-474-6671
Mailing Address - Fax:623-474-6629
Practice Address - Street 1:19818 W US HIGHWAY 85
Practice Address - Street 2:
Practice Address - City:BUCKEYE
Practice Address - State:AZ
Practice Address - Zip Code:85326-9258
Practice Address - Country:US
Practice Address - Phone:623-327-2815
Practice Address - Fax:623-327-2819
Is Sole Proprietor?:No
Enumeration Date:2017-06-06
Last Update Date:2017-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLP046816164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse