Individual
MISTY DAWN GONZALES
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
4200 SE ADAMS RD, BARTLESVILLE, OK 74006-8448
(918) 331-9050
Mailing address
4200 SE ADAMS RD, BARTLESVILLE, OK 74006-8448
(918) 331-9050
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1003365867
GROUP NPI
OK
Enumeration date
09/05/2019
Last updated
09/05/2019
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