1821427055 NPI number — MS. ANDREA GONZALEZ PA-C

Table of content: MS. ANDREA GONZALEZ PA-C (NPI 1821427055)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1821427055 NPI number — MS. ANDREA GONZALEZ PA-C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GONZALEZ
Provider First Name:
ANDREA
Provider Middle Name:
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
PA-C
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1821427055
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/29/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
HQ SPECIAL OPERATIONS CMD EUR
Provider Second Line Business Mailing Address:
ATTN: SOHC MAJ ANDREA GONZALEZ
Provider Business Mailing Address City Name:
APO
Provider Business Mailing Address State Name:
AE
Provider Business Mailing Address Postal Code:
09131-0400
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
324-379-4042
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
650 JOEL DR
Provider Second Line Business Practice Location Address:
ATTN: CREDENTIALS OFFICE
Provider Business Practice Location Address City Name:
FORT CAMPBELL
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
42223-5318
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
270-956-8106
Provider Business Practice Location Address Fax Number:
270-256-8106
Provider Enumeration Date:
11/07/2013

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363A00000X , with the licence number:  1115660 ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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