Provider Demographics
NPI:1497452544
Name:WELSCH, BRENNA (PA-C)
Entity Type:Individual
Prefix:
First Name:BRENNA
Middle Name:
Last Name:WELSCH
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:BRENNA
Other - Middle Name:SHEA
Other - Last Name:O'CONNOR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:12255 S 80TH AVE STE 203
Mailing Address - Street 2:
Mailing Address - City:PALOS HEIGHTS
Mailing Address - State:IL
Mailing Address - Zip Code:60463-1284
Mailing Address - Country:US
Mailing Address - Phone:708-827-2021
Mailing Address - Fax:708-827-2241
Practice Address - Street 1:12255 S 80TH AVE STE 203
Practice Address - Street 2:
Practice Address - City:PALOS HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:60463-1284
Practice Address - Country:US
Practice Address - Phone:708-827-2021
Practice Address - Fax:708-827-2241
Is Sole Proprietor?:No
Enumeration Date:2023-02-09
Last Update Date:2023-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant