Provider Demographics
NPI:1932430501
Name:VELASCO, ANITA (ACNP)
Entity Type:Individual
Prefix:MRS
First Name:ANITA
Middle Name:
Last Name:VELASCO
Suffix:
Gender:F
Credentials:ACNP
Other - Prefix:MISS
Other - First Name:ANITA
Other - Middle Name:M
Other - Last Name:LUCERO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 740018
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30374-0018
Mailing Address - Country:US
Mailing Address - Phone:312-773-9730
Mailing Address - Fax:773-866-8014
Practice Address - Street 1:4208 CENTRAL AVE SW STE G
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87105-1695
Practice Address - Country:US
Practice Address - Phone:505-777-3001
Practice Address - Fax:505-808-4977
Is Sole Proprietor?:No
Enumeration Date:2010-01-21
Last Update Date:2021-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMR31406163WE0003X
NM01587363LA2100X
NMCNP01587363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
No163WE0003XNursing Service ProvidersRegistered NurseEmergency