Healthcare Provider Details

I. General information

NPI: 1952248304
Provider Name (Legal Business Name): NICHOLAS ANDREW GONZALEZ NREMT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/04/2026
Last Update Date: 05/04/2026
Certification Date: 05/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1068 GRAY CT APT 9
GREEN BAY WI
54303-3724
US

IV. Provider business mailing address

1068 GRAY CT APT 9
GREEN BAY WI
54303-3724
US

V. Phone/Fax

Practice location:
  • Phone: 773-512-8023
  • Fax:
Mailing address:
  • Phone: 773-512-8023
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code146N00000X
TaxonomyBasic Emergency Medical Technician
License Number70123466
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: