Provider Demographics
NPI:1821894643
Name:GONZAGA, MAROLYN
Entity type:Individual
Prefix:MS
First Name:MAROLYN
Middle Name:
Last Name:GONZAGA
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:748 E MILITARY AVE
Mailing Address - Street 2:
Mailing Address - City:FREMONT
Mailing Address - State:NE
Mailing Address - Zip Code:68025-5183
Mailing Address - Country:US
Mailing Address - Phone:402-595-0231
Mailing Address - Fax:
Practice Address - Street 1:1839 OHIO ST
Practice Address - Street 2:
Practice Address - City:FREMONT
Practice Address - State:NE
Practice Address - Zip Code:68025-2178
Practice Address - Country:US
Practice Address - Phone:402-936-4540
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-21
Last Update Date:2025-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes373H00000XNursing Service Related ProvidersDay Training/Habilitation Specialist