Healthcare Provider Details

I. General information

NPI: 1972142362
Provider Name (Legal Business Name): LAUREN BETH GONZI RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/02/2020
Last Update Date: 01/02/2020
Certification Date: 01/02/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3800 JANES RD STE 101
ARCATA CA
95521-4742
US

IV. Provider business mailing address

1275 8TH ST
ARCATA CA
95521-5770
US

V. Phone/Fax

Practice location:
  • Phone: 707-822-1385
  • Fax: 707-825-8203
Mailing address:
  • Phone: 707-826-8633
  • Fax: 707-826-8628

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number843227
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: