Provider Demographics
NPI:1043774995
Name:VELARDE, JANIE M
Entity Type:Individual
Prefix:
First Name:JANIE
Middle Name:M
Last Name:VELARDE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2604 KESSLER AVE
Mailing Address - Street 2:
Mailing Address - City:MIDLAND
Mailing Address - State:TX
Mailing Address - Zip Code:79701-3114
Mailing Address - Country:US
Mailing Address - Phone:432-661-8344
Mailing Address - Fax:
Practice Address - Street 1:4321 CEDAR SPRING DR
Practice Address - Street 2:
Practice Address - City:MIDLAND
Practice Address - State:TX
Practice Address - Zip Code:79703-6424
Practice Address - Country:US
Practice Address - Phone:432-262-3121
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-24
Last Update Date:2019-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX527324156Medicaid