Provider Demographics
NPI:1235726605
Name:GONZALEZ THOMPSON, ELIZABETH MARIE
Entity Type:Individual
Prefix:
First Name:ELIZABETH MARIE
Middle Name:
Last Name:GONZALEZ THOMPSON
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 1:5180 DESERT LN
Mailing Address - Street 2:
Mailing Address - City:STAGECOACH
Mailing Address - State:NV
Mailing Address - Zip Code:89429-9211
Mailing Address - Country:US
Mailing Address - Phone:775-301-3437
Mailing Address - Fax:
Practice Address - Street 1:775 FLEISCHMANN WAY
Practice Address - Street 2:
Practice Address - City:CARSON CITY
Practice Address - State:NV
Practice Address - Zip Code:89703-2995
Practice Address - Country:US
Practice Address - Phone:775-445-7773
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-30
Last Update Date:2020-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator