Individual
CAMILLE M GONZALES
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CNP
Contact information
Practice address
454 ST MICHAELS DR STE 200, SANTA FE, NM 87505-7602
(505) 303-5000
Mailing address
PO BOX 26666, PROVIDER ENROLLMENT, ALBUQUERQUE, NM 87125-6666
(505) 923-6770
(505) 923-5354
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
R38444
NM
363LF0000X
Family Nurse Practitioner
Primary
CNP00843
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
54704316
—
NM
Enumeration date
10/13/2005
Last updated
04/13/2022
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