Provider Demographics
NPI:1952512220
Name:GONZALEZ, JACQUELINE SUZANNE (RN)
Entity Type:Individual
Prefix:MS
First Name:JACQUELINE
Middle Name:SUZANNE
Last Name:GONZALEZ
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 WOOD AVE S
Mailing Address - Street 2:
Mailing Address - City:ISELIN
Mailing Address - State:NJ
Mailing Address - Zip Code:08830-2749
Mailing Address - Country:US
Mailing Address - Phone:732-452-6000
Mailing Address - Fax:
Practice Address - Street 1:101 WOOD AVE S
Practice Address - Street 2:
Practice Address - City:ISELIN
Practice Address - State:NJ
Practice Address - Zip Code:08830-2749
Practice Address - Country:US
Practice Address - Phone:732-452-6000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-25
Last Update Date:2013-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NO10241000163WA2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WA2000XNursing Service ProvidersRegistered NurseAdministrator