Provider Demographics
NPI:1851951321
Name:GOMEZ, MARCIAL COLE (LPN)
Entity Type:Individual
Prefix:MR
First Name:MARCIAL
Middle Name:COLE
Last Name:GOMEZ
Suffix:
Gender:M
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2718 S 49TH ST
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:KS
Mailing Address - Zip Code:66106-3526
Mailing Address - Country:US
Mailing Address - Phone:816-287-2016
Mailing Address - Fax:
Practice Address - Street 1:2718 S 49TH ST
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:KS
Practice Address - Zip Code:66106-3526
Practice Address - Country:US
Practice Address - Phone:816-287-2016
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-17
Last Update Date:2023-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS25-52168-112164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes164W00000XNursing Service ProvidersLicensed Practical NurseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS25-52168-112OtherPRACTICAL NURSE