Provider Demographics
NPI:1881311249
Name:GONZALES, LOUISE STEFHANIE (PA-C)
Entity type:Individual
Prefix:
First Name:LOUISE STEFHANIE
Middle Name:
Last Name:GONZALES
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 E ROBINSON ST STE 2300
Mailing Address - Street 2:
Mailing Address - City:NORMAN
Mailing Address - State:OK
Mailing Address - Zip Code:73071-6671
Mailing Address - Country:US
Mailing Address - Phone:405-329-4102
Mailing Address - Fax:
Practice Address - Street 1:500 E ROBINSON ST STE 2300
Practice Address - Street 2:
Practice Address - City:NORMAN
Practice Address - State:OK
Practice Address - Zip Code:73071-6671
Practice Address - Country:US
Practice Address - Phone:405-329-4102
Practice Address - Fax:405-307-5625
Is Sole Proprietor?:No
Enumeration Date:2022-10-25
Last Update Date:2022-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK4872363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant