Provider Demographics
NPI:1417177387
Name:WELCH, LAURIE JEAN (RN)
Entity Type:Individual
Prefix:
First Name:LAURIE
Middle Name:JEAN
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:N984 VINNE HAHA RD
Mailing Address - Street 2:
Mailing Address - City:FORT ATKINSON
Mailing Address - State:WI
Mailing Address - Zip Code:53538-8710
Mailing Address - Country:US
Mailing Address - Phone:920-568-9806
Mailing Address - Fax:
Practice Address - Street 1:N984 VINNE HAHA RD
Practice Address - Street 2:
Practice Address - City:FORT ATKINSON
Practice Address - State:WI
Practice Address - Zip Code:53538-8710
Practice Address - Country:US
Practice Address - Phone:920-568-9806
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI38315200Medicaid