Provider Demographics
NPI:1760758601
Name:GONZALEZ, CAROL ANN (RN)
Entity Type:Individual
Prefix:MS
First Name:CAROL
Middle Name:ANN
Last Name:GONZALEZ
Suffix:
Gender:F
Credentials:RN
Other - Prefix:MS
Other - First Name:CAROL
Other - Middle Name:ANN
Other - Last Name:LOUDERBACK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:511 SEVENTH AVENUE
Mailing Address - Street 2:SUITE 107
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11215
Mailing Address - Country:US
Mailing Address - Phone:718-447-5891
Mailing Address - Fax:
Practice Address - Street 1:511 7TH AVE
Practice Address - Street 2:SUITE 107
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11215-6126
Practice Address - Country:US
Practice Address - Phone:718-369-2583
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-26
Last Update Date:2012-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY466079163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse