Provider Demographics
NPI:1477137651
Name:WELCH, SANTONIA
Entity Type:Individual
Prefix:
First Name:SANTONIA
Middle Name:
Last Name:WELCH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10145 CABANA CLUB DR
Mailing Address - Street 2:
Mailing Address - City:SAINT ANN
Mailing Address - State:MO
Mailing Address - Zip Code:63074-1730
Mailing Address - Country:US
Mailing Address - Phone:314-255-4124
Mailing Address - Fax:
Practice Address - Street 1:10145 CABANA CLUB DR
Practice Address - Street 2:
Practice Address - City:SAINT ANN
Practice Address - State:MO
Practice Address - Zip Code:63074-1730
Practice Address - Country:US
Practice Address - Phone:314-255-4124
Practice Address - Fax:314-255-4124
Is Sole Proprietor?:No
Enumeration Date:2021-05-12
Last Update Date:2021-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2011004774163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse