Healthcare Provider Details

I. General information

NPI: 1407132418
Provider Name (Legal Business Name): KAREN E. GONZALEZ RD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/24/2011
Last Update Date: 07/16/2025
Certification Date: 07/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14555 W NATIONAL AVE
NEW BERLIN WI
53151-4494
US

IV. Provider business mailing address

PO BOX 735044
CHICAGO IL
60673-5044
US

V. Phone/Fax

Practice location:
  • Phone: 262-827-3636
  • Fax:
Mailing address:
  • Phone: 800-326-2250
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number2318
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: