Provider Demographics
NPI:1053691915
Name:GONZALES, SANDRA KAYE (APN/FNP-BC)
Entity type:Individual
Prefix:
First Name:SANDRA
Middle Name:KAYE
Last Name:GONZALES
Suffix:
Gender:F
Credentials:APN/FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:54 LILLIAN LN
Mailing Address - Street 2:
Mailing Address - City:YORKVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60560-9622
Mailing Address - Country:US
Mailing Address - Phone:630-742-0610
Mailing Address - Fax:
Practice Address - Street 1:54 LILLIAN LN
Practice Address - Street 2:
Practice Address - City:YORKVILLE
Practice Address - State:IL
Practice Address - Zip Code:60560-9622
Practice Address - Country:US
Practice Address - Phone:630-553-7668
Practice Address - Fax:630-806-8589
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-24
Last Update Date:2021-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209008984363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily