Provider Demographics
NPI:1205349511
Name:GONZALES, HALEY LAUREN (RN, BSN, IBCLC)
Entity type:Individual
Prefix:MRS
First Name:HALEY
Middle Name:LAUREN
Last Name:GONZALES
Suffix:
Gender:F
Credentials:RN, BSN, IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1413 PLEASANT HILL DR
Mailing Address - Street 2:
Mailing Address - City:PLATTE CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64079-7631
Mailing Address - Country:US
Mailing Address - Phone:704-451-0410
Mailing Address - Fax:
Practice Address - Street 1:1413 PLEASANT HILL DR
Practice Address - Street 2:
Practice Address - City:PLATTE CITY
Practice Address - State:MO
Practice Address - Zip Code:64079-7631
Practice Address - Country:US
Practice Address - Phone:704-451-0410
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-11-08
Last Update Date:2023-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC255580163W00000X
MOL-310829163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant
No163W00000XNursing Service ProvidersRegistered Nurse