Provider Demographics
NPI:1750614376
Name:GONZALEZ, MARIAELENA (FNP-C)
Entity type:Individual
Prefix:
First Name:MARIAELENA
Middle Name:
Last Name:GONZALEZ
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:MARIA ELENA
Other - Middle Name:
Other - Last Name:GONZALEZ
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:FNP-C
Mailing Address - Street 1:103 LIVINGSTON LOOP STE B4
Mailing Address - Street 2:
Mailing Address - City:SANTA TERESA
Mailing Address - State:NM
Mailing Address - Zip Code:88008-9747
Mailing Address - Country:US
Mailing Address - Phone:915-888-9115
Mailing Address - Fax:915-995-4972
Practice Address - Street 1:103 LIVINGSTON LOOP STE B4
Practice Address - Street 2:
Practice Address - City:SANTA TERESA
Practice Address - State:NM
Practice Address - Zip Code:88008-9747
Practice Address - Country:US
Practice Address - Phone:915-888-9115
Practice Address - Fax:915-995-4972
Is Sole Proprietor?:No
Enumeration Date:2009-09-14
Last Update Date:2024-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMCNP-02301363LF0000X
TX678490363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1831267079OtherGROUP NPI
TX130880104OtherGROUP MEDICAID
TX742505561OtherGROUP TAX ID
TX451901OtherGROUP MEDICARE PTAN