Provider Demographics
NPI:1063237279
Name:GONZALES, MARCO ANTONIO (MSN RN)
Entity type:Individual
Prefix:
First Name:MARCO
Middle Name:ANTONIO
Last Name:GONZALES
Suffix:
Gender:M
Credentials:MSN RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:214 BECKY LANE
Mailing Address - Street 2:N/A
Mailing Address - City:EDINBURG
Mailing Address - State:TX
Mailing Address - Zip Code:78541
Mailing Address - Country:US
Mailing Address - Phone:956-252-3284
Mailing Address - Fax:
Practice Address - Street 1:214 BECKY LANE
Practice Address - Street 2:N/A
Practice Address - City:EDINBURG
Practice Address - State:TX
Practice Address - Zip Code:78541
Practice Address - Country:US
Practice Address - Phone:956-252-3284
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-21
Last Update Date:2024-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX884955163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163W00000XNursing Service ProvidersRegistered NurseGroup - Single Specialty