Provider Demographics
NPI:1295702249
Name:VELOSO, MIMI ECHIVARRE (CRNA)
Entity type:Individual
Prefix:MS
First Name:MIMI
Middle Name:ECHIVARRE
Last Name:VELOSO
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:CMR 442 BOX 192
Mailing Address - Street 2:
Mailing Address - City:APO
Mailing Address - State:AE
Mailing Address - Zip Code:09042
Mailing Address - Country:DE
Mailing Address - Phone:490622-470-2626
Mailing Address - Fax:
Practice Address - Street 1:KARLSRUHER STRASSE 144
Practice Address - Street 2:
Practice Address - City:HEIDELBERG
Practice Address - State:BADEN WIRTEMBURG
Practice Address - Zip Code:69126
Practice Address - Country:DE
Practice Address - Phone:490622-117-2616
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1380162367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered