Healthcare Provider Details

I. General information

NPI: 1427960152
Provider Name (Legal Business Name): ABIGAIL GONZALEZ RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/18/2026
Last Update Date: 09/18/2026
Certification Date: 09/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2605 E CREEKS EDGE DR
BLOOMINGTON IN
47401-8368
US

IV. Provider business mailing address

1607 S ANDREW CIR
BLOOMINGTON IN
47401-7149
US

V. Phone/Fax

Practice location:
  • Phone: 812-353-2071
  • Fax: 812-918-5920
Mailing address:
  • Phone: 717-599-6947
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WS0121X
TaxonomyPlastic Surgery Registered Nurse
License Number28266047C
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: