Healthcare Provider Details

I. General information

NPI: 1821910381
Provider Name (Legal Business Name): MARCELA GONZALEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/28/2026
Last Update Date: 07/28/2026
Certification Date: 07/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

342 N MAIN ST
WEST HARTFORD CT
06117-2500
US

IV. Provider business mailing address

153 PARSONAGE ST
ROCKY HILL CT
06067-2105
US

V. Phone/Fax

Practice location:
  • Phone: 860-478-4314
  • Fax:
Mailing address:
  • Phone: 860-478-4314
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number17595
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: