Provider Demographics
NPI:1013156108
Name:VELAZQUEZ-NOLL, ELIZABETH N (MD)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:N
Last Name:VELAZQUEZ-NOLL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:ELIZABETH
Other - Middle Name:N
Other - Last Name:FISCHER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 635283
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45263-5283
Mailing Address - Country:US
Mailing Address - Phone:859-371-1153
Mailing Address - Fax:859-647-5113
Practice Address - Street 1:7766 EWING BLVD
Practice Address - Street 2:SUITE L
Practice Address - City:FLORENCE
Practice Address - State:KY
Practice Address - Zip Code:41042-7537
Practice Address - Country:US
Practice Address - Phone:859-371-1153
Practice Address - Fax:859-647-5113
Is Sole Proprietor?:No
Enumeration Date:2009-02-12
Last Update Date:2023-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY42918207Q00000X
KYR1671207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KYP00847801OtherRAILROAD MEDICARE
KY7100134200Medicaid
OH3107686Medicaid
KYP400021145Medicare PIN