Provider Demographics
NPI:1790235687
Name:GONZALEZ, NANCY NATALIE (PA-C)
Entity Type:Individual
Prefix:
First Name:NANCY
Middle Name:NATALIE
Last Name:GONZALEZ
Suffix:
Gender:F
Credentials:PA-C
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Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4675 W 20TH STREET RD UNIT B
Mailing Address - Street 2:
Mailing Address - City:GREELEY
Mailing Address - State:CO
Mailing Address - Zip Code:80634-3260
Mailing Address - Country:US
Mailing Address - Phone:970-373-4625
Mailing Address - Fax:970-431-5999
Practice Address - Street 1:4675 W 20TH STREET RD UNIT B
Practice Address - Street 2:
Practice Address - City:GREELEY
Practice Address - State:CO
Practice Address - Zip Code:80634-3260
Practice Address - Country:US
Practice Address - Phone:970-373-4625
Practice Address - Fax:970-431-5999
Is Sole Proprietor?:No
Enumeration Date:2016-10-04
Last Update Date:2023-12-28
Deactivation Date:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO9000142069Medicaid
CO560839YL0XMedicare PIN