Provider Demographics
NPI:1538290101
Name:WELCH, JENNIFER VIVIAN (RN)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:VIVIAN
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 1:6 BEACON ST
Mailing Address - Street 2:
Mailing Address - City:GENEVA
Mailing Address - State:NY
Mailing Address - Zip Code:14456-2702
Mailing Address - Country:US
Mailing Address - Phone:315-781-7270
Mailing Address - Fax:
Practice Address - Street 1:1083 WATERLOO GENEVA RD
Practice Address - Street 2:
Practice Address - City:WATERLOO
Practice Address - State:NY
Practice Address - Zip Code:13165-1202
Practice Address - Country:US
Practice Address - Phone:315-539-4049
Practice Address - Fax:315-539-4394
Is Sole Proprietor?:No
Enumeration Date:2007-03-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY475616-1163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse