Provider Demographics
NPI:1255648820
Name:GONZALES, DONNA BUSH (RN)
Entity type:Individual
Prefix:MS
First Name:DONNA
Middle Name:BUSH
Last Name:GONZALES
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:DONNA
Other - Middle Name:MARIE
Other - Last Name:BUSH
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1210 N 5TH AVE
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85003-1225
Mailing Address - Country:US
Mailing Address - Phone:602-257-3891
Mailing Address - Fax:602-257-3923
Practice Address - Street 1:1210 N 5TH AVE
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85003-1225
Practice Address - Country:US
Practice Address - Phone:602-257-3891
Practice Address - Fax:602-257-3923
Is Sole Proprietor?:No
Enumeration Date:2010-09-02
Last Update Date:2010-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN161408163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZRN161408OtherREGISTERED NURSE