Provider Demographics
NPI:1831874502
Name:GONZALEZ, MARILYN CELINE (PA)
Entity type:Individual
Prefix:
First Name:MARILYN
Middle Name:CELINE
Last Name:GONZALEZ
Suffix:
Gender:F
Credentials:PA
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Other - Credentials:
Mailing Address - Street 1:26333 S IVY LN
Mailing Address - Street 2:
Mailing Address - City:CHANNAHON
Mailing Address - State:IL
Mailing Address - Zip Code:60410-3336
Mailing Address - Country:US
Mailing Address - Phone:815-505-0041
Mailing Address - Fax:
Practice Address - Street 1:1000 BLYTHE BLVD
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28203-5812
Practice Address - Country:US
Practice Address - Phone:336-716-4264
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-20
Last Update Date:2024-10-04
Deactivation Date:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical