Healthcare Provider Details

I. General information

NPI: 1043612419
Provider Name (Legal Business Name): MS. APRIL DAWN GONZALES
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/17/2014
Last Update Date: 05/05/2022
Certification Date: 05/05/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 E MOUNTAIN DR
WILKES BARRE PA
18711-0027
US

IV. Provider business mailing address

100 N ACADEMY AVE
DANVILLE PA
17822-4903
US

V. Phone/Fax

Practice location:
  • Phone: 570-808-7399
  • Fax: 570-808-5942
Mailing address:
  • Phone: 570-271-6144
  • Fax: 570-271-6578

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberMA057111
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: