Individual
JESSICA LYNN GONZALEZ
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1805 34TH ST W, WILLISTON, ND 58801-2360
(406) 478-4236
Mailing address
1805 34TH ST W, WILLISTON, ND 58801-2360
(406) 478-4236
Taxonomy
Speciality
Code
Description
License number
State
3747P1801X
Personal Care Attendant
Primary
—
ND
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3747P1801X
—
ND
Enumeration date
05/19/2021
Last updated
05/19/2021
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