Provider Demographics
NPI:1063270403
Name:PRO HEALTH SOLUTIONS LLC
Entity type:Organization
Organization Name:PRO HEALTH SOLUTIONS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/EMPLOYEE
Authorized Official - Prefix:
Authorized Official - First Name:MARINA
Authorized Official - Middle Name:C
Authorized Official - Last Name:GONZALES
Authorized Official - Suffix:
Authorized Official - Credentials:FNP-C
Authorized Official - Phone:308-765-9671
Mailing Address - Street 1:190226 UNIVERSITY ST
Mailing Address - Street 2:
Mailing Address - City:SCOTTSBLUFF
Mailing Address - State:NE
Mailing Address - Zip Code:69361-5752
Mailing Address - Country:US
Mailing Address - Phone:308-765-9671
Mailing Address - Fax:
Practice Address - Street 1:190226 UNIVERSITY ST
Practice Address - Street 2:
Practice Address - City:SCOTTSBLUFF
Practice Address - State:NE
Practice Address - Zip Code:69361-5752
Practice Address - Country:US
Practice Address - Phone:308-765-9671
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-03-11
Last Update Date:2024-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care