Provider Demographics
NPI:1851951321
Name:GOMEZ, MARCIAL COLE (LPN)
Entity type:Individual
Prefix:MR
First Name:MARCIAL
Middle Name:COLE
Last Name:GOMEZ
Suffix:
Gender:M
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:50 E 13TH ST UNIT 812
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64106-2935
Mailing Address - Country:US
Mailing Address - Phone:816-287-2016
Mailing Address - Fax:
Practice Address - Street 1:50 E 13TH ST UNIT 812
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64106-2935
Practice Address - Country:US
Practice Address - Phone:816-287-2016
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-17
Last Update Date:2025-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS25-52168-112164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes164W00000XNursing Service ProvidersLicensed Practical NurseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS25-52168-112OtherPRACTICAL NURSE