Provider Demographics
NPI:1992084164
Name:GONZALES, NICOLLE L (CNM)
Entity type:Individual
Prefix:
First Name:NICOLLE
Middle Name:L
Last Name:GONZALES
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4133 MONTGOMERY BLVD NE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87109-6741
Mailing Address - Country:US
Mailing Address - Phone:505-660-6372
Mailing Address - Fax:505-393-5165
Practice Address - Street 1:4133 MONTGOMERY BLVD NE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87109-6741
Practice Address - Country:US
Practice Address - Phone:505-660-6372
Practice Address - Fax:505-393-5165
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-05
Last Update Date:2022-12-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NM625367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife