MRS. ENRIQUETA R GOMEZ


Address: 900 Technology Way Ste 280, Libertyville, IL 60048-5364
Phone: 8475490588

MRS. ENRIQUETA R GOMEZ (NPI# 1770041832) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).

Provider Overview

Nation Provider ID (NPI) 1770041832
Entity Type Individual
Full Name MRS. ENRIQUETA R GOMEZ
Credential NP-C
Practice Address 900 Technology Way Ste 280
Libertyville
IL 60048-5364
Mailing Address 7438 W Jonquil Ter
Niles
IL 60714-3104
Practice Telephone 8475490588
Mailing Telephone 8474143869
Enumeration Date 2019-03-07
Last Update Date 2019-03-07
Gender Code F
Is Sole Proprietor N

Taxonomy

Primary Taxonomy Code Classification License Number License State Taxonomy Group
Y 363LG0600X Nurse Practitioner
Specialization: Gerontology
209017095 IL Physician Assistants & Advanced Practice Nursing Providers

Office Location

Street Address 900 TECHNOLOGY WAY STE 280
City LIBERTYVILLE
State IL
Zip Code 60048-5364

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Taxonomy Information

Taxonomy Code 363LG0600X
Grouping Physician Assistants & Advanced Practice Nursing Providers
Classification Nurse Practitioner
Specialization Gerontology

Taxonomy Definition

Definition to come...

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Competitor

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City LIBERTYVILLE
Zip Code 60048

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Dataset Information

Data Provider Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES)
Jurisdiction Medicare & Medicaid

This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.

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