Provider Demographics
NPI:1700217585
Name:GONZALEZ, THAIS (CNA)
Entity type:Individual
Prefix:
First Name:THAIS
Middle Name:
Last Name:GONZALEZ
Suffix:
Gender:F
Credentials:CNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:416 GANTT DR
Mailing Address - Street 2:
Mailing Address - City:MARTINSBURG
Mailing Address - State:WV
Mailing Address - Zip Code:25403-0281
Mailing Address - Country:US
Mailing Address - Phone:240-506-1217
Mailing Address - Fax:
Practice Address - Street 1:416 GANTT DR
Practice Address - Street 2:
Practice Address - City:MARTINSBURG
Practice Address - State:WV
Practice Address - Zip Code:25403-0281
Practice Address - Country:US
Practice Address - Phone:240-506-1217
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-12-04
Last Update Date:2013-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL52358376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide