Provider Demographics
NPI:1366862625
Name:WELCH, TERESA (RN)
Entity Type:Individual
Prefix:
First Name:TERESA
Middle Name:
Last Name:WELCH
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1635 W RUTLEDGE AVE
Mailing Address - Street 2:
Mailing Address - City:GAFFNEY
Mailing Address - State:SC
Mailing Address - Zip Code:29341-1023
Mailing Address - Country:US
Mailing Address - Phone:864-219-0376
Mailing Address - Fax:864-487-2728
Practice Address - Street 1:400 S LOGAN ST
Practice Address - Street 2:
Practice Address - City:GAFFNEY
Practice Address - State:SC
Practice Address - Zip Code:29341-1609
Practice Address - Country:US
Practice Address - Phone:864-487-2705
Practice Address - Fax:864-487-2728
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-24
Last Update Date:2014-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC113245163WC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC1500XNursing Service ProvidersRegistered NurseCommunity Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC1922164326OtherDHEC