Basic Information
| Provider Information | |||||||||
| NPI: | 1588030373 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GONZALES | ||||||||
| FirstName: | GREZELRO | ||||||||
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| Credential: | FNP-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 840 W BLACKHAWK ST | ||||||||
| Address2: | 1811 | ||||||||
| City: | CHICAGO | ||||||||
| State: | IL | ||||||||
| PostalCode: | 606422592 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6308772893 | ||||||||
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| Practice Location | |||||||||
| Address1: | 840 W IRVING PARK RD | ||||||||
| Address2: | 301 | ||||||||
| City: | CHICAGO | ||||||||
| State: | IL | ||||||||
| PostalCode: | 606133011 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7739753269 | ||||||||
| FaxNumber: | 7739753270 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/15/2015 | ||||||||
| LastUpdateDate: | 04/24/2016 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | 209.012989 | IL | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.