MEDICARE: KAREN LYNN GONZALEZ RN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163W00000X	Registered Nurse	200641512RN	OR

General Provider Information

NPI Number	:	1457661050
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KAREN LYNN GONZALEZ RN

Provider Business Mailing Address
First Line	:	931 CHEVY WAY
Second Line	:
City	:	MEDFORD
State	:	OR
Zip	:	97504-4127
Country	:	US
Telephone Number	:	541-535-6239
Fax Number	:	541-535-4377

Provider Business Practice Location Address
First Line	:	806 N 6TH AVE
Second Line	:
City	:	GOLD HILL
State	:	OR
Zip	:	97525-9762
Country	:	US
Telephone Number	:	541-494-6818
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/15/2010
Last Update Date	:	08/12/2022

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