Provider Demographics
NPI:1508601071
Name:GONZALEZ, CARMEN VIRGINIA (RN)
Entity type:Individual
Prefix:MRS
First Name:CARMEN
Middle Name:VIRGINIA
Last Name:GONZALEZ
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:74 POCOTOPAUG DR
Mailing Address - Street 2:
Mailing Address - City:EAST HAMPTON
Mailing Address - State:CT
Mailing Address - Zip Code:06424-1377
Mailing Address - Country:US
Mailing Address - Phone:347-843-9323
Mailing Address - Fax:
Practice Address - Street 1:74 POCOTOPAUG DR
Practice Address - Street 2:
Practice Address - City:EAST HAMPTON
Practice Address - State:CT
Practice Address - Zip Code:06424-1377
Practice Address - Country:US
Practice Address - Phone:347-843-9323
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-27
Last Update Date:2024-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT183177163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse