Provider Demographics
NPI:1235675273
Name:GONZALES, EDITH (ANP-CNP)
Entity type:Individual
Prefix:
First Name:EDITH
Middle Name:
Last Name:GONZALES
Suffix:
Gender:F
Credentials:ANP-CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2650 RIDGE AVE STE 1223
Mailing Address - Street 2:
Mailing Address - City:EVANSTON
Mailing Address - State:IL
Mailing Address - Zip Code:60201-1700
Mailing Address - Country:US
Mailing Address - Phone:847-570-2040
Mailing Address - Fax:
Practice Address - Street 1:5140 N CALIFORNIA AVE STE 700
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60625-3657
Practice Address - Country:US
Practice Address - Phone:773-989-3957
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-01-15
Last Update Date:2025-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209015015363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care