Provider Demographics
NPI:1265091714
Name:GONZALEZ, MARANATHA (FNP-BC)
Entity type:Individual
Prefix:MR
First Name:MARANATHA
Middle Name:
Last Name:GONZALEZ
Suffix:
Gender:M
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5538 ZION RIDGE TER
Mailing Address - Street 2:
Mailing Address - City:NORTH CHESTERFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:23234-4595
Mailing Address - Country:US
Mailing Address - Phone:804-937-4990
Mailing Address - Fax:
Practice Address - Street 1:5538 ZION RIDGE TER
Practice Address - Street 2:
Practice Address - City:NORTH CHESTERFIELD
Practice Address - State:VA
Practice Address - Zip Code:23234-4595
Practice Address - Country:US
Practice Address - Phone:804-937-4990
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-09
Last Update Date:2019-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024177650363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily