| Doctor Name: | MR. JOHN DANIEL VAN DE VELDE |
| NPI Number: | 1922089804 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | PNP |
| License Number: | RN252140 |
| Business Practice Address: | 2050 2nd St Se Kirtland Afb, NM - 871175524 |
| Business Phone Number: | 5058463702 |
| Business Fax Number: | 5058536290 |
| Mailing Address: | 9000 Sand Sage Place, ALBUQUERQUE |
| State: | NM |
| Postal Code: | 871170001 |
| Phone Number: | 5058463114 |
| Fax Number: | 5058536290 |
| NPI Enumeration Date: | 11/08/2005 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 163WP0200X |
| License Number: | RN252140 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | OH |
| Taxonomy Type: | Nursing Service Providers |
| Taxonomy Classification: | Registered Nurse |
| Taxonomy Specialization: | Pediatrics |
| Taxonomy Definition: | |