Provider Demographics
NPI:1043349806
Name:GONZALES, LA FON ELLEN (RN)
Entity Type:Individual
Prefix:MRS
First Name:LA FON
Middle Name:ELLEN
Last Name:GONZALES
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:310 STARLITE DR
Mailing Address - Street 2:
Mailing Address - City:PUEBLO
Mailing Address - State:CO
Mailing Address - Zip Code:81005-2683
Mailing Address - Country:US
Mailing Address - Phone:719-564-4667
Mailing Address - Fax:719-583-4439
Practice Address - Street 1:151 CENTRAL MAIN ST
Practice Address - Street 2:PUEBLO CITY COUNTY HEALTH DEPT.
Practice Address - City:PUEBLO
Practice Address - State:CO
Practice Address - Zip Code:81003-4212
Practice Address - Country:US
Practice Address - Phone:719-544-7435
Practice Address - Fax:719-583-4439
Is Sole Proprietor?:No
Enumeration Date:2007-03-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO103271163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse