Healthcare Provider Details

I. General information

NPI: 1861356925
Provider Name (Legal Business Name): HEIDY LYNDA GONZALEZ I RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/12/2025
Last Update Date: 12/12/2025
Certification Date: 12/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

133 STETSON DR
CHARLOTTE NC
28262-3326
US

IV. Provider business mailing address

6513 CHERRYCREST LN
CHARLOTTE NC
28217-4363
US

V. Phone/Fax

Practice location:
  • Phone: 704-596-5606
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number383278
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: