Provider Demographics
NPI:1245415157
Name:WELCH, WILLIAM M
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:M
Last Name:WELCH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:515 S MOORE ST
Mailing Address - Street 2:
Mailing Address - City:BLUE EARTH
Mailing Address - State:MN
Mailing Address - Zip Code:56013-2158
Mailing Address - Country:US
Mailing Address - Phone:507-526-3273
Mailing Address - Fax:
Practice Address - Street 1:515 S MOORE ST
Practice Address - Street 2:
Practice Address - City:BLUE EARTH
Practice Address - State:MN
Practice Address - Zip Code:56013-2158
Practice Address - Country:US
Practice Address - Phone:507-526-3273
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-01-09
Last Update Date:2022-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NDR33686367500000X
MNR 167887-1367500000X
DEL6-0A10903367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered