Healthcare Provider Details

I. General information

NPI: 1548131642
Provider Name (Legal Business Name): WENDY VELEZ CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/13/2025
Last Update Date: 09/16/2026
Certification Date: 09/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 CENTRAL AVE
TULAROSA NM
88352-2063
US

IV. Provider business mailing address

111 CENTRAL AVE
TULAROSA NM
88352-2063
US

V. Phone/Fax

Practice location:
  • Phone: 575-585-1250
  • Fax: 505-443-8328
Mailing address:
  • Phone: 575-585-1250
  • Fax: 505-443-8328

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number67716
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: