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NPI Code Detail

MEDICARE: ABIGAIL GONZALEZ

MEDICARE: ABIGAIL GONZALEZ
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
1164W00000XLicensed Practical NurseLP61352086WA

General Provider Information

NPI Number : 1902681737
Entity Type Code : Individual
Provider Name (Legal Business Name) : ABIGAIL GONZALEZ
Provider Business Mailing Address
First Line : 2712 S 12TH ST APT 1
Second Line :
City : TACOMA
State : WA
Zip : 98405-2744
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 4411 BROWNS POINT BLVD
Second Line :
City : TACOMA
State : WA
Zip : 98422-2041
Country : US
Telephone Number : 253-925-9220
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/29/2023
Last Update Date : 08/29/2023

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Directions to “ ABIGAIL GONZALEZ ” Practice Location

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