Healthcare Provider Details

I. General information

NPI: 1831388495
Provider Name (Legal Business Name): MILISSA ANNE GONZALES LPN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MILISSA ANNE GONZALES LPN

II. Dates (important events)

Enumeration Date: 10/19/2007
Last Update Date: 09/24/2026
Certification Date: 09/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11 GARIBALDI AVE
OAKFIELD NY
14125-1208
US

IV. Provider business mailing address

11 GARIBALDI AVE
OAKFIELD NY
14125-1208
US

V. Phone/Fax

Practice location:
  • Phone: 585-409-9485
  • Fax:
Mailing address:
  • Phone: 585-409-9485
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License Number219724
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: