Healthcare Provider Details

I. General information

NPI: 1427211671
Provider Name (Legal Business Name): NATALIE DAWN VELASQUEZ M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/08/2008
Last Update Date: 08/28/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 S KNIK GOOSE BAY RD
WASILLA AK
99654-8083
US

IV. Provider business mailing address

189 E NELSON AVE # 273
WASILLA AK
99654-6462
US

V. Phone/Fax

Practice location:
  • Phone: 907-631-7437
  • Fax:
Mailing address:
  • Phone: 412-477-0853
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number7341
License Number StateAK
# 2
Primary TaxonomyN
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License NumberMD441083
License Number StatePA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: