Provider Demographics
NPI:1346721867
Name:WELCH, GINA M (DNP, FNP-BC, APNP)
Entity Type:Individual
Prefix:
First Name:GINA
Middle Name:M
Last Name:WELCH
Suffix:
Gender:F
Credentials:DNP, FNP-BC, APNP
Other - Prefix:
Other - First Name:GINA
Other - Middle Name:M
Other - Last Name:THOMPSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:11400 W LAKE PARK DR
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53224-3035
Mailing Address - Country:US
Mailing Address - Phone:414-365-8300
Mailing Address - Fax:414-365-8330
Practice Address - Street 1:11400 W LAKE PARK DR
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53224-3035
Practice Address - Country:US
Practice Address - Phone:414-365-8300
Practice Address - Fax:414-365-8330
Is Sole Proprietor?:No
Enumeration Date:2018-08-23
Last Update Date:2018-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI8600-33363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI8600-33OtherSTATE OF WISCONSIN - DEPARTMENT OF SAFETY & PROFESSIONAL SERVICES