Provider Demographics
NPI:1013638998
Name:GONZALES, LISA AYN (MIDWIFE)
Entity Type:Individual
Prefix:MRS
First Name:LISA
Middle Name:AYN
Last Name:GONZALES
Suffix:
Gender:F
Credentials:MIDWIFE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:517 WASHINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:BELLEFONTAINE
Mailing Address - State:OH
Mailing Address - Zip Code:43311-1843
Mailing Address - Country:US
Mailing Address - Phone:937-407-6906
Mailing Address - Fax:
Practice Address - Street 1:517 WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:BELLEFONTAINE
Practice Address - State:OH
Practice Address - Zip Code:43311-1843
Practice Address - Country:US
Practice Address - Phone:937-407-6906
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-08
Last Update Date:2022-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes176B00000XOther Service ProvidersMidwifeGroup - Single Specialty