Provider Demographics
NPI:1588453856
Name:MORALES GONZALEZ, LAZARA MARILA
Entity type:Individual
Prefix:
First Name:LAZARA
Middle Name:MARILA
Last Name:MORALES GONZALEZ
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1417 N WHEELER AVE
Mailing Address - Street 2:
Mailing Address - City:GRAND ISLAND
Mailing Address - State:NE
Mailing Address - Zip Code:68801-3667
Mailing Address - Country:US
Mailing Address - Phone:308-267-3081
Mailing Address - Fax:
Practice Address - Street 1:1417 N WHEELER AVE
Practice Address - Street 2:
Practice Address - City:GRAND ISLAND
Practice Address - State:NE
Practice Address - Zip Code:68801-3667
Practice Address - Country:US
Practice Address - Phone:308-267-3081
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-05-03
Last Update Date:2025-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant