MEDICARE: MS. STACIE GONZALEZ VELEZ PA-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363AM0700X	Medical Physician Assistant	0010-01503	NC

General Provider Information

NPI Number	:	1588815559
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. STACIE GONZALEZ VELEZ PA-C

Provider Business Mailing Address
First Line	:	7212 GB ALFORD HWY
Second Line	:
City	:	HOLLY SPRINGS
State	:	NC
Zip	:	27540-7661
Country	:	US
Telephone Number	:	919-552-1520
Fax Number	:	919-552-8792

Provider Business Practice Location Address
First Line	:	7212 GB ALFORD HWY
Second Line	:
City	:	HOLLY SPRINGS
State	:	NC
Zip	:	27540-7661
Country	:	US
Telephone Number	:	919-552-1520
Fax Number	:	919-552-8792

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/08/2008
Last Update Date	:	07/27/2014

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