Provider Demographics
NPI:1235686668
Name:WELNETZ, KEVIN (LMT, CNA)
Entity Type:Individual
Prefix:
First Name:KEVIN
Middle Name:
Last Name:WELNETZ
Suffix:
Gender:M
Credentials:LMT, CNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1355 OAK ST STE 100
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97401-3566
Mailing Address - Country:US
Mailing Address - Phone:541-683-1125
Mailing Address - Fax:
Practice Address - Street 1:1355 OAK ST STE 100
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97401-3566
Practice Address - Country:US
Practice Address - Phone:541-683-1125
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-09-01
Last Update Date:2016-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR201506675CNA376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide