Provider Demographics
NPI:1659028678
Name:GONZALEZ, GEORGIANA SUE (FNP-BC)
Entity Type:Individual
Prefix:MS
First Name:GEORGIANA
Middle Name:SUE
Last Name:GONZALEZ
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:GEORGIANA
Other - Middle Name:SUE
Other - Last Name:GONZALEZ
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:901 E 104TH ST
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64131-4517
Mailing Address - Country:US
Mailing Address - Phone:816-932-0288
Mailing Address - Fax:816-932-7490
Practice Address - Street 1:4400 BROADWAY BLVD STE 400
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64111-3342
Practice Address - Country:US
Practice Address - Phone:816-932-0288
Practice Address - Fax:816-932-7490
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-09
Last Update Date:2022-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2021043564363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner