Provider Demographics
NPI:1881997518
Name:GONZALEZ, ANNETTE R (RN)
Entity type:Individual
Prefix:
First Name:ANNETTE
Middle Name:R
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 1:1602 E MI 10 N
Mailing Address - Street 2:
Mailing Address - City:DONNA
Mailing Address - State:TX
Mailing Address - Zip Code:78537-8144
Mailing Address - Country:US
Mailing Address - Phone:956-463-3402
Mailing Address - Fax:
Practice Address - Street 1:1602 E MI 10 N
Practice Address - Street 2:
Practice Address - City:DONNA
Practice Address - State:TX
Practice Address - Zip Code:78537-8144
Practice Address - Country:US
Practice Address - Phone:956-463-6402
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-20
Last Update Date:2011-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX527129163WC0400X, 171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No163WC0400XNursing Service ProvidersRegistered NurseCase Management