Individual provider Active NPI

Sheryl Gonzalez, NP-C

  • Family Nurse Practitioner
  • Jackson, MI
National Provider Identifier
1013452192
Registry record updated Feb 26, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
4704169668 Issued in MI
Practice address
3100 Cooper St
Jackson, MI 49201-7545
Phone
(517) 780-6157
NPI assigned
Dec 28, 2016
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Feb 26, 2017

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Registered Nurse 163W00000X 4704169668 MI
Family Nurse Practitioner 363LF0000X 4704169668 MI Primary

Addresses

Primary practice location

3100 Cooper St
Jackson, MI 49201-7545

Mailing address

6977 Placeway St
Jackson, MI 49201-9704
Phone (517) 262-5226

Other identifiers 1

IdentifierTypeStateIssuer
1013452192MedicaidMI

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
4704169668MIMDFamily Nurse Practitioner

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1482883200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1488067200000",
    "number": "1013452192",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6977 PLACEWAY ST",
            "city": "JACKSON",
            "state": "MI",
            "postal_code": "492019704",
            "telephone_number": "517-262-5226"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3100 COOPER ST",
            "city": "JACKSON",
            "state": "MI",
            "postal_code": "492017545",
            "telephone_number": "517-780-6157"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GONZALEZ",
        "first_name": "SHERYL",
        "credential": "NP-C",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2016-12-28",
        "last_updated": "2017-02-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "MI",
            "license": "4704169668",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "MI",
            "license": "4704169668",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1013452192",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Jackson, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 26, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.