Individual
MRS. KAITLYN GONZALEZ
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
790 PARK AVE, HUNTINGTON, NY 11743-4516
(631) 427-3700
Mailing address
790 PARK AVE, HUNTINGTON, NY 11743-4516
(631) 427-3700
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
692965-1
NY
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
F405403-01
NY
Other
Enumeration date
12/09/2018
Last updated
11/08/2023
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