Provider Demographics
NPI:1437462736
Name:ALTENHEIN, VELDINA RAYE (NNP-BC)
Entity Type:Individual
Prefix:
First Name:VELDINA
Middle Name:RAYE
Last Name:ALTENHEIN
Suffix:
Gender:F
Credentials:NNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7720 N 16TH ST
Mailing Address - Street 2:STE 425
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85020-4492
Mailing Address - Country:US
Mailing Address - Phone:602-476-8962
Mailing Address - Fax:623-643-9236
Practice Address - Street 1:7720 N 16TH ST
Practice Address - Street 2:STE 425
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85020-4492
Practice Address - Country:US
Practice Address - Phone:602-476-8962
Practice Address - Fax:623-643-9236
Is Sole Proprietor?:No
Enumeration Date:2010-07-15
Last Update Date:2014-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAP5777363L00000X
AZRN038045163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ628512Medicaid
AZZ147364Medicare PIN