Individual
SUSAN GONZALEZ
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
CNP
Contact information
Practice address
2550 UNIVERSITY AVE W STE 229N, SAINT PAUL, MN 55114-1902
(651) 645-3115
Mailing address
4100 E 27TH ST, MINNEAPOLIS, MN 55406-1804
(612) 216-8640
Taxonomy
Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
1088
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
5008775780
BCBSMI
MI
Enumeration date
12/02/2008
Last updated
08/28/2023
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