Provider Demographics
NPI:1912230731
Name:VELEZ, BONNIE (NP)
Entity Type:Individual
Prefix:
First Name:BONNIE
Middle Name:
Last Name:VELEZ
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:656 KIMBERLY WAY
Mailing Address - Street 2:
Mailing Address - City:STEVENSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21666-2400
Mailing Address - Country:US
Mailing Address - Phone:410-924-7879
Mailing Address - Fax:
Practice Address - Street 1:204 MEDICAL CENTER RD
Practice Address - Street 2:
Practice Address - City:GRASONVILLE
Practice Address - State:MD
Practice Address - Zip Code:21638-1386
Practice Address - Country:US
Practice Address - Phone:410-827-7117
Practice Address - Fax:410-827-9030
Is Sole Proprietor?:No
Enumeration Date:2009-09-11
Last Update Date:2020-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR162299363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD045501600Medicaid
MD045501600Medicaid