Individual
KATHLEEN GONZALES
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP
Contact information
Practice address
613 BISBEE RD, BISBEE, AZ 85603-1305
(520) 432-7287
Mailing address
613 BISBEE RD, BISBEE, AZ 85603-1305
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
AP1844
AZ
363LF0000X
Family Nurse Practitioner
RN083567
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
824062
—
AZ
Enumeration date
09/22/2005
Last updated
06/12/2013
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