Provider Demographics
NPI:1619672136
Name:GONZALES, BROOKLYNN FAY (RN, IBCLC)
Entity Type:Individual
Prefix:
First Name:BROOKLYNN
Middle Name:FAY
Last Name:GONZALES
Suffix:
Gender:F
Credentials:RN, IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1472 MORNING GLORY LN
Mailing Address - Street 2:
Mailing Address - City:ROSEVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95747-7532
Mailing Address - Country:US
Mailing Address - Phone:916-805-7227
Mailing Address - Fax:
Practice Address - Street 1:1472 MORNING GLORY LN
Practice Address - Street 2:
Practice Address - City:ROSEVILLE
Practice Address - State:CA
Practice Address - Zip Code:95747-7532
Practice Address - Country:US
Practice Address - Phone:916-805-7227
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-03
Last Update Date:2023-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95085152163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant