Provider Demographics
NPI:1972941821
Name:GONZALEZ, JEANNE CAMERON (ARNP, APRN)
Entity Type:Individual
Prefix:
First Name:JEANNE
Middle Name:CAMERON
Last Name:GONZALEZ
Suffix:
Gender:F
Credentials:ARNP, APRN
Other - Prefix:
Other - First Name:SHIRLEY
Other - Middle Name:JEANNE
Other - Last Name:CAMERON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 896129
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28289-6129
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:504 HUNTINGTON RD
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29615-4212
Practice Address - Country:US
Practice Address - Phone:864-412-0447
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-06-12
Last Update Date:2014-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCSC APRN 18198363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCSC2668D196Medicare PIN