Provider Demographics
NPI:1417944372
Name:WELCH, MARY BYRNE (RN FNP, AOCN)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:BYRNE
Last Name:WELCH
Suffix:
Gender:F
Credentials:RN FNP, AOCN
Other - Prefix:
Other - First Name:MARY
Other - Middle Name:CATHERINE
Other - Last Name:BYRNE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN, MS, FNP, AOCN
Mailing Address - Street 1:2810 LONG BEACH BLVD
Mailing Address - Street 2:TODD CANCER INSTITUTE AT LONG BEACH MEMORIAL
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90806
Mailing Address - Country:US
Mailing Address - Phone:562-933-0961
Mailing Address - Fax:560-933-0960
Practice Address - Street 1:2810 LONG BEACH BL
Practice Address - Street 2:TODD CANCER INSTITUTE AT LONG BEACH MEMORIAL
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90806
Practice Address - Country:US
Practice Address - Phone:562-933-0961
Practice Address - Fax:560-933-0960
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-05
Last Update Date:2018-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARN479278363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
500022897OtherRAILROAD MEDICARE
NPO114960OtherBLUE SHIELD
WNP11496BMedicare ID - Type Unspecified
WNP11496AMedicare ID - Type Unspecified
NPO114960OtherBLUE SHIELD