MEDICARE: CHRISTINE GONZALES NP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LG0600X	Gerontology Nurse Practitioner	0993302	CO
2	363LA2200X	Adult Health Nurse Practitioner	0993302	CO

General Provider Information

NPI Number	:	1881110088
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHRISTINE GONZALES NP

Provider Business Mailing Address
First Line	:	2739 E LAS VEGAS ST
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80906-1594
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2739 E LAS VEGAS ST
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80906
Country	:	US
Telephone Number	:	719-390-2000
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/18/2017
Last Update Date	:	06/23/2018

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