Provider Demographics
NPI:1861707069
Name:VELASQUEZ, MICHELLE R (APN)
Entity type:Individual
Prefix:MS
First Name:MICHELLE
Middle Name:R
Last Name:VELASQUEZ
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4424 S EASTERN AVE
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89119-7825
Mailing Address - Country:US
Mailing Address - Phone:702-732-7440
Mailing Address - Fax:702-732-9672
Practice Address - Street 1:4424 S EASTERN AVE
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89119-7825
Practice Address - Country:US
Practice Address - Phone:702-732-7440
Practice Address - Fax:702-732-9672
Is Sole Proprietor?:No
Enumeration Date:2010-08-11
Last Update Date:2011-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVAPN001219363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVEF634ZMedicare PIN