Provider Demographics
NPI:1245844364
Name:GOMEZ, ASIA ANN (NP)
Entity type:Individual
Prefix:
First Name:ASIA
Middle Name:ANN
Last Name:GOMEZ
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2816 E ALLISON AVE
Mailing Address - Street 2:
Mailing Address - City:CUDAHY
Mailing Address - State:WI
Mailing Address - Zip Code:53110-2541
Mailing Address - Country:US
Mailing Address - Phone:414-349-7458
Mailing Address - Fax:
Practice Address - Street 1:2816 E ALLISON AVE
Practice Address - Street 2:
Practice Address - City:CUDAHY
Practice Address - State:WI
Practice Address - Zip Code:53110-2541
Practice Address - Country:US
Practice Address - Phone:414-349-7458
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-04
Last Update Date:2020-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI10274-33363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily