Provider Demographics
NPI:1891055745
Name:VELASQUEZ, EVA SUSANA (PMHNP-BC)
Entity Type:Individual
Prefix:MS
First Name:EVA
Middle Name:SUSANA
Last Name:VELASQUEZ
Suffix:
Gender:F
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7850 JEFFERSON ST NE STE 300
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87109-4314
Mailing Address - Country:US
Mailing Address - Phone:505-884-1114
Mailing Address - Fax:
Practice Address - Street 1:7850 JEFFERSON ST NE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87109-4315
Practice Address - Country:US
Practice Address - Phone:505-884-1114
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-25
Last Update Date:2023-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMR63354163W00000X
NMCNP-02045363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse