Provider Demographics
NPI:1003520735
Name:GONZALEZ, NICOLAS NOEL (RN)
Entity Type:Individual
Prefix:
First Name:NICOLAS
Middle Name:NOEL
Last Name:GONZALEZ
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14039 BRADLEY RD
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79938-8645
Mailing Address - Country:US
Mailing Address - Phone:915-252-9491
Mailing Address - Fax:
Practice Address - Street 1:14039 BRADLEY RD
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79938-8645
Practice Address - Country:US
Practice Address - Phone:915-252-9491
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-09
Last Update Date:2023-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX905748163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse