Healthcare Provider Details

I. General information

NPI: 1245169069
Provider Name (Legal Business Name): IRIS MABEL MEDINA GONZALEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/18/2026
Last Update Date: 05/18/2026
Certification Date: 05/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2563 44TH AVE
COLUMBUS NE
68601-8511
US

IV. Provider business mailing address

921 ELK ST
SCHUYLER NE
68661-2036
US

V. Phone/Fax

Practice location:
  • Phone: 402-564-0815
  • Fax:
Mailing address:
  • Phone: 402-615-0129
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: