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NPI Code Detail

MEDICARE: CHRISTINE GONZALES NP

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
1363LG0600XGerontology Nurse Practitioner0993302CO
2363LA2200XAdult Health Nurse Practitioner0993302CO

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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