Provider Demographics
NPI:1043634207
Name:GONZALES, ELSA MARIE (MSN, NP-C)
Entity Type:Individual
Prefix:MRS
First Name:ELSA
Middle Name:MARIE
Last Name:GONZALES
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Gender:F
Credentials:MSN, NP-C
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Mailing Address - Street 1:PO BOX 26666
Mailing Address - Street 2:PHS PROVIDER ENROLLMENT
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87125-6666
Mailing Address - Country:US
Mailing Address - Phone:505-923-6770
Mailing Address - Fax:505-923-5354
Practice Address - Street 1:200 EMILIO LOPEZ RD NW
Practice Address - Street 2:
Practice Address - City:LOS LUNAS
Practice Address - State:NM
Practice Address - Zip Code:87031-6818
Practice Address - Country:US
Practice Address - Phone:505-866-2700
Practice Address - Fax:505-866-2701
Is Sole Proprietor?:No
Enumeration Date:2014-02-08
Last Update Date:2016-01-14
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NMCNP-02354363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily