Provider Demographics
NPI:1083869853
Name:VELAZQUEZ, ROBERT NICHOLAS (CRNA)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:NICHOLAS
Last Name:VELAZQUEZ
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 6989 MSC 18913
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97228-6989
Mailing Address - Country:US
Mailing Address - Phone:206-858-7000
Mailing Address - Fax:206-858-7050
Practice Address - Street 1:10330 MERIDIAN AVE N
Practice Address - Street 2:SUITE 370
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98133-9451
Practice Address - Country:US
Practice Address - Phone:206-528-6000
Practice Address - Fax:206-528-0014
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-20
Last Update Date:2016-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI153838-30367500000X
WAAP60466104367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered