Individual
SHIVANNA SUBRAMANI GONZALEZ
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
DNP
Contact information
Practice address
504 WOLCOTT RD, WOLCOTT, CT 06716-2461
(203) 725-5339
Mailing address
504 WOLCOTT RD STE C, WOLCOTT, CT 06716-2462
(860) 714-2913
(860) 714-8988
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
009553
CT
363LF0000X
Family Nurse Practitioner
5993
CT
363LP2300X
Primary Care Nurse Practitioner
5993
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
005993
STATE LICENSE
CT
Enumeration date
11/24/2014
Last updated
05/12/2023
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