Provider Demographics
NPI:1356783328
Name:GONZALEZ, MERCEDES SIENTO (RN)
Entity type:Individual
Prefix:MS
First Name:MERCEDES
Middle Name:SIENTO
Last Name:GONZALEZ
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2027 NE MULTNOMAH ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97232-2188
Mailing Address - Country:US
Mailing Address - Phone:503-288-3932
Mailing Address - Fax:503-288-3932
Practice Address - Street 1:2027 NE MULTNOMAH ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97232-2188
Practice Address - Country:US
Practice Address - Phone:503-288-3932
Practice Address - Fax:503-288-3932
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-19
Last Update Date:2013-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA077039751 RN163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health