Provider Demographics
NPI:1548627128
Name:GOMEZ, NATALEE RENAE
Entity type:Individual
Prefix:MRS
First Name:NATALEE
Middle Name:RENAE
Last Name:GOMEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:NATALEE
Other - Middle Name:RENAE
Other - Last Name:WOLLMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1400 BAILEY CT
Mailing Address - Street 2:
Mailing Address - City:GREEN RIVER
Mailing Address - State:WY
Mailing Address - Zip Code:82935-6115
Mailing Address - Country:US
Mailing Address - Phone:307-870-8451
Mailing Address - Fax:
Practice Address - Street 1:1400 BAILEY CT
Practice Address - Street 2:
Practice Address - City:GREEN RIVER
Practice Address - State:WY
Practice Address - Zip Code:82935-6115
Practice Address - Country:US
Practice Address - Phone:307-870-8451
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-27
Last Update Date:2016-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator