Healthcare Provider Details

I. General information

NPI: 1669342382
Provider Name (Legal Business Name): MANUELITA FATIMA GONZALEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/07/2025
Last Update Date: 11/11/2025
Certification Date: 11/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

114 S CHESTNUT ST
NORTH PLATTE NE
69101-4060
US

IV. Provider business mailing address

110 N BAILEY AVE
NORTH PLATTE NE
69101-5436
US

V. Phone/Fax

Practice location:
  • Phone: 308-532-4860
  • Fax:
Mailing address:
  • Phone: 308-534-0440
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: