Provider Demographics
NPI:1609574664
Name:WELCH, CHARLEI ANNETTE
Entity Type:Individual
Prefix:
First Name:CHARLEI
Middle Name:ANNETTE
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 1:902 MARTIN LUTHER KING BLVD
Mailing Address - Street 2:
Mailing Address - City:WAGONER
Mailing Address - State:OK
Mailing Address - Zip Code:74467-6928
Mailing Address - Country:US
Mailing Address - Phone:918-316-8180
Mailing Address - Fax:
Practice Address - Street 1:902 MARTIN LUTHER KING BLVD
Practice Address - Street 2:
Practice Address - City:WAGONER
Practice Address - State:OK
Practice Address - Zip Code:74467-6928
Practice Address - Country:US
Practice Address - Phone:918-316-8180
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-20
Last Update Date:2023-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist