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 1:203 ROMANCOKE RD STE 203-205
Mailing Address - Street 2:
Mailing Address - City:STEVENSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21666-2678
Mailing Address - Country:US
Mailing Address - Phone:410-200-3114
Mailing Address - Fax:800-682-0650
Practice Address - Street 1:203 ROMANCOKE RD STE 202-203
Practice Address - Street 2:
Practice Address - City:STEVENSVILLE
Practice Address - State:MD
Practice Address - Zip Code:21666-2678
Practice Address - Country:US
Practice Address - Phone:410-200-8330
Practice Address - Fax:800-682-0650
Is Sole Proprietor?:No
Enumeration Date:2009-09-11
Last Update Date:2025-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR162299363LF0000X, 207QA0401X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No207QA0401XAllopathic & Osteopathic PhysiciansFamily MedicineAddiction Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD045501600Medicaid
MD045501600Medicaid