Healthcare Provider Details

I. General information

NPI: 1295702249
Provider Name (Legal Business Name): MIMI ECHIVARRE VELOSO CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 03/08/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

KARLSRUHER STRASSE 144
HEIDELBERG BADEN WIRTEMBURG
69126
DE

IV. Provider business mailing address

CMR 442 BOX 192
APO AE
09042
DE

V. Phone/Fax

Practice location:
  • Phone: 4906221172616
  • Fax:
Mailing address:
  • Phone: 4906224702626
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number1380162
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: