MEDICARE: MS. DORIS KAY GONZALES CNP

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
1	363LF0000X	Family Nurse Practitioner	CNP01425	NM

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1992701759
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. DORIS KAY GONZALES CNP

Provider Business Mailing Address
First Line	:	4005 HIGH RESORT BLVD SE
Second Line	:	PMG RIO RANCHO HIGH RESORT 4005
City	:	RIO RANCHO
State	:	NM
Zip	:	87124-5906
Country	:	US
Telephone Number	:	505-462-6000
Fax Number	:

Provider Business Practice Location Address
First Line	:	4005 HIGH RESORT BLVD SE
Second Line	:	PMG RIO RANCHO HIGH RESORT 4005
City	:	RIO RANCHO
State	:	NM
Zip	:	87124-5906
Country	:	US
Telephone Number	:	505-462-6000
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/24/2005
Last Update Date	:	10/24/2014

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