Provider Demographics
NPI:1013715382
Name:GONZALES, JILL (MSN, APRN, WHNP-BC)
Entity type:Individual
Prefix:
First Name:JILL
Middle Name:
Last Name:GONZALES
Suffix:
Gender:F
Credentials:MSN, APRN, WHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12910 TOTEM LAKE BLVD NE STE 102
Mailing Address - Street 2:
Mailing Address - City:KIRKLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98034-2901
Mailing Address - Country:US
Mailing Address - Phone:425-899-4455
Mailing Address - Fax:
Practice Address - Street 1:12910 TOTEM LAKE BLVD NE STE 102
Practice Address - Street 2:
Practice Address - City:KIRKLAND
Practice Address - State:WA
Practice Address - Zip Code:98034-2901
Practice Address - Country:US
Practice Address - Phone:425-899-4455
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-04
Last Update Date:2025-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP61662646363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health