Provider Demographics
NPI:1881788271
Name:VELAZQUEZ, FRANK A (CRNA)
Entity type:Individual
Prefix:
First Name:FRANK
Middle Name:A
Last Name:VELAZQUEZ
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3016 PADDY LN
Mailing Address - Street 2:PHS PROVIDER ENROLLMENT
Mailing Address - City:LOVELAND
Mailing Address - State:CO
Mailing Address - Zip Code:80537-8798
Mailing Address - Country:US
Mailing Address - Phone:970-669-2104
Mailing Address - Fax:970-669-2104
Practice Address - Street 1:301 E MIEL DE LUNA AVE
Practice Address - Street 2:DAN C. TRIGG MEM HOSP
Practice Address - City:TUCUMCARI
Practice Address - State:NM
Practice Address - Zip Code:88401-3810
Practice Address - Country:US
Practice Address - Phone:575-461-7000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2009-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMCRNA00766367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM87982773Medicaid
NMNM302439Medicare PIN
NMNM302438Medicare PIN
R19672Medicare UPIN
NM348612201Medicare PIN
NMNM301629Medicare PIN
NM87982773Medicaid