MEDICARE: MS. EVA SUSANA VELASQUEZ PMHNP-BC

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	163W00000X	Registered Nurse	R63354	NM
2	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	CNP-02045	NM

General Provider Information

NPI Number	:	1891055745
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. EVA SUSANA VELASQUEZ PMHNP-BC

Provider Business Mailing Address
First Line	:	7850 JEFFERSON ST NE STE 300
Second Line	:
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87109-4314
Country	:	US
Telephone Number	:	505-884-1114
Fax Number	:

Provider Business Practice Location Address
First Line	:	7850 JEFFERSON ST NE
Second Line	:
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87109-4315
Country	:	US
Telephone Number	:	505-884-1114
Fax Number	:

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

Provider Enumeration Date	:	05/25/2012
Last Update Date	:	01/06/2023

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