Individual
JEFFREY MICHAEL GONZALES
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
FNP C
Contact information
Practice address
1253 NW CANAL BLVD, REDMOND, OR 97756-1334
(541) 548-8131
(541) 526-6608
Mailing address
505 S 336TH ST, SUITE 600, FEDERAL WAY, WA 98003-6328
(253) 838-6180
(253) 838-6418
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
200650104NP
OR
363L00000X
Nurse Practitioner
A-103474
IA
363L00000X
Nurse Practitioner
AP04764
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0213580
LIWA
WA
01
—
5971GO
BSWA
WA
05
—
8187320
—
WA
Enumeration date
06/13/2006
Last updated
06/07/2013
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