Healthcare Provider Details

I. General information

NPI: 1326864240
Provider Name (Legal Business Name): MYRNA D VELAZQUEZ RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/25/2024
Last Update Date: 11/25/2024
Certification Date: 11/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30 STEVENS ST STE I
NORWALK CT
06850-3859
US

IV. Provider business mailing address

1445 CAPITOL AVE
BRIDGEPORT CT
06604-1619
US

V. Phone/Fax

Practice location:
  • Phone: 203-852-3073
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WW0101X
TaxonomyAmbulatory Women's Health Care Registered Nurse
License Number84831
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: