Provider Demographics
NPI:1780081224
Name:GONSALES, SHELBY (APRN, FNP-BC)
Entity type:Individual
Prefix:
First Name:SHELBY
Middle Name:
Last Name:GONSALES
Suffix:
Gender:F
Credentials:APRN, FNP-BC
Other - Prefix:
Other - First Name:SHELBY
Other - Middle Name:
Other - Last Name:MCQUOWN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4801 DEER CRK
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:OH
Mailing Address - Zip Code:45042-5805
Mailing Address - Country:US
Mailing Address - Phone:937-867-7700
Mailing Address - Fax:
Practice Address - Street 1:3290 VILLAGE DR
Practice Address - Street 2:
Practice Address - City:FRANKLIN
Practice Address - State:OH
Practice Address - Zip Code:45005-5692
Practice Address - Country:US
Practice Address - Phone:937-867-7700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-11-27
Last Update Date:2023-11-16
Deactivation Date:2015-04-20
Deactivation Code:
Reactivation Date:2021-01-26
Provider Licenses
StateLicense IDTaxonomies
OHAPRN.CNP.0028190363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty