Basic Information
Provider Information
NPI: 1003000985
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: GONSALVES
FirstName: PATRICIA
MiddleName: MAE
NamePrefix: MS.
NameSuffix:  
Credential: RN
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 7001A EAST PKWY
Address2: SUITE 600
City: SACRAMENTO
State: CA
PostalCode: 958232501
CountryCode: US
TelephoneNumber: 9168755000
FaxNumber:  
Practice Location
Address1: 7171 BOWLING DR
Address2: SUITE 800
City: SACRAMENTO
State: CA
PostalCode: 958232034
CountryCode: US
TelephoneNumber: 9168755000
FaxNumber:  
Other Information
ProviderEnumerationDate: 09/04/2007
LastUpdateDate: 09/04/2007
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
163W00000X197225CAY Nursing Service ProvidersRegistered Nurse 

No ID Information.


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