Provider Demographics
NPI:1508444993
Name:GONZALEZ, ANGEL MARIE
Entity Type:Individual
Prefix:PROF
First Name:ANGEL
Middle Name:MARIE
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 1:1223 14TH ST NW LOT 57
Mailing Address - Street 2:
Mailing Address - City:DEVILS LAKE
Mailing Address - State:ND
Mailing Address - Zip Code:58301-4203
Mailing Address - Country:US
Mailing Address - Phone:701-381-8022
Mailing Address - Fax:
Practice Address - Street 1:1223 14TH ST NW LOT 57
Practice Address - Street 2:
Practice Address - City:DEVILS LAKE
Practice Address - State:ND
Practice Address - Zip Code:58301-4203
Practice Address - Country:US
Practice Address - Phone:701-381-8022
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-29
Last Update Date:2021-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
376J00000X
ND376J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker