Provider Demographics
NPI:1114690302
Name:GONZALEZ, DIANE LYNN
Entity Type:Individual
Prefix:
First Name:DIANE
Middle Name:LYNN
Last Name:GONZALEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1509 CONSTITUTION DR
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:NE
Mailing Address - Zip Code:68850-1144
Mailing Address - Country:US
Mailing Address - Phone:308-325-7119
Mailing Address - Fax:
Practice Address - Street 1:2305 PATRIOT DR
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:NE
Practice Address - Zip Code:68850-1272
Practice Address - Country:US
Practice Address - Phone:308-325-7119
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-26
Last Update Date:2021-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes385H00000XRespite Care FacilityRespite Care