Provider Demographics
NPI:1841034873
Name:GONZALEZ, JELIZSA (LPN)
Entity type:Individual
Prefix:
First Name:JELIZSA
Middle Name:
Last Name:GONZALEZ
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:862 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:BRENTWOOD
Mailing Address - State:NY
Mailing Address - Zip Code:11717-7531
Mailing Address - Country:US
Mailing Address - Phone:631-538-6868
Mailing Address - Fax:
Practice Address - Street 1:862 BROADWAY
Practice Address - Street 2:
Practice Address - City:BRENTWOOD
Practice Address - State:NY
Practice Address - Zip Code:11717-7531
Practice Address - Country:US
Practice Address - Phone:631-538-6868
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-24
Last Update Date:2024-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY350337164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse