Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207N00000X | Dermatologist | MD451018 | PA |
Y | 207ND0101X | MOHS-Micrographic Surgeon | MD451018 | PA |
N | 207ND0900X | Dermatopathologist | MD451018 | PA |
N | 207NS0135X | Procedural Dermatology | MD451018 | PA |
NPI | 1205095486 |
---|---|
Provider Name | Nicole F Velez |
First Address | Danville, PA 17822-4903 |
Second Address | State College, PA 16801-7974 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/06/2008 |
Last Update Date | 28/08/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1029155970003 | (05) | PA |
12596642 | CAQH (01) | PA |