Basic Information
| Provider Information | |||||||||
| NPI: | 1265787030 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GONZALEZ | ||||||||
| FirstName: | SUSSY | ||||||||
| MiddleName: | A | ||||||||
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| Credential: | RNFA, ANP-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6400 FANNIN ST STE 1700 | ||||||||
| Address2: | |||||||||
| City: | HOUSTON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 770301526 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7134866000 | ||||||||
| FaxNumber: | 7134866049 | ||||||||
| Practice Location | |||||||||
| Address1: | 10905 MEMORIAL HERMANN DR STE 130 | ||||||||
| Address2: | |||||||||
| City: | PEARLAND | ||||||||
| State: | TX | ||||||||
| PostalCode: | 775843773 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7134866000 | ||||||||
| FaxNumber: | 7134866000 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/18/2012 | ||||||||
| LastUpdateDate: | 01/19/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 01/19/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163WR0006X | 707614 | TX | N | Nursing Service Providers | Registered Nurse | Registered Nurse First Assistant | 363LA2200X | C-APN.0000215-C-NP | CO | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Adult Health | 363LA2200X | 707614 | TX | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Adult Health |
No ID Information.