Provider Demographics
NPI:1639409089
Name:GONZALES, ARIEL HENRIE (MSN, APRN, P/MHNP)
Entity Type:Individual
Prefix:MRS
First Name:ARIEL
Middle Name:HENRIE
Last Name:GONZALES
Suffix:
Gender:F
Credentials:MSN, APRN, P/MHNP
Other - Prefix:
Other - First Name:ARIEL
Other - Middle Name:
Other - Last Name:HENRIE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5691 S REDWOOD RD
Mailing Address - Street 2:BLDG. 16, SUITE 1B
Mailing Address - City:TAYLORSVILLE
Mailing Address - State:UT
Mailing Address - Zip Code:84123-5420
Mailing Address - Country:US
Mailing Address - Phone:801-746-7190
Mailing Address - Fax:866-284-3243
Practice Address - Street 1:5691 S REDWOOD RD
Practice Address - Street 2:BLDG. 16, SUITE 1B
Practice Address - City:TAYLORSVILLE
Practice Address - State:UT
Practice Address - Zip Code:84123-5420
Practice Address - Country:US
Practice Address - Phone:801-746-7190
Practice Address - Fax:866-284-3243
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-07
Last Update Date:2014-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT6794362-3102163W00000X
UT6794362-4408363LP0808X
UT6794362-4405363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse