Provider Demographics
NPI:1376186379
Name:WELCH, JESSICA (LPN-IV)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:
Last Name:WELCH
Suffix:
Gender:F
Credentials:LPN-IV
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:245 E 208TH ST
Mailing Address - Street 2:
Mailing Address - City:EUCLID
Mailing Address - State:OH
Mailing Address - Zip Code:44123-1811
Mailing Address - Country:US
Mailing Address - Phone:216-860-5082
Mailing Address - Fax:
Practice Address - Street 1:245 E 208TH ST
Practice Address - Street 2:
Practice Address - City:EUCLID
Practice Address - State:OH
Practice Address - Zip Code:44123-1811
Practice Address - Country:US
Practice Address - Phone:216-860-5082
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-22
Last Update Date:2021-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHLPN.167528.MEDS-IV164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse