Healthcare Provider Details

I. General information

NPI: 1154867307
Provider Name (Legal Business Name): MARIA ISABEL GONCALVES NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/12/2017
Last Update Date: 09/21/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

55 N MAIN ST
FREEPORT NY
11520-2243
US

IV. Provider business mailing address

PO BOX 249 E3
YADKINVILLE NC
27055-0249
US

V. Phone/Fax

Practice location:
  • Phone: 516-377-8014
  • Fax: 516-377-8017
Mailing address:
  • Phone: 336-679-4963
  • Fax: 336-679-2549

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number340347
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: