MEDICARE: MRS. JUANA R VELARDE RN

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	441880-1	NY

General Provider Information

NPI Number	:	1972879757
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. JUANA R VELARDE RN

Provider Business Mailing Address
First Line	:	1537 WASHINGTON AVE
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10457-8308
Country	:	US
Telephone Number	:	718-583-1690
Fax Number	:	718-583-7345

Provider Business Practice Location Address
First Line	:	1537 WASHINGTON AVENUE
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10457
Country	:	US
Telephone Number	:	718-583-1690
Fax Number	:	718-583-7345

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

Provider Enumeration Date	:	03/27/2012
Last Update Date	:	03/27/2012

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