Provider Demographics
NPI:1245568625
Name:VELEZ, JOANNE (OWNER)
Entity Type:Individual
Prefix:MS
First Name:JOANNE
Middle Name:
Last Name:VELEZ
Suffix:
Gender:F
Credentials:OWNER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:711 S MAIN
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67213
Mailing Address - Country:US
Mailing Address - Phone:316-204-9005
Mailing Address - Fax:316-263-3817
Practice Address - Street 1:711 S MAIN
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67213
Practice Address - Country:US
Practice Address - Phone:316-204-9005
Practice Address - Fax:316-263-3817
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-24
Last Update Date:2010-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KSA087136251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS200624480BMedicaid
KS200624480AMedicaid