Provider Demographics
NPI:1619235603
Name:WELCH, MARIE C (RN)
Entity Type:Individual
Prefix:MRS
First Name:MARIE
Middle Name:C
Last Name:WELCH
Suffix:
Gender:F
Credentials:RN
Other - Prefix:MS
Other - First Name:MARIE
Other - Middle Name:C
Other - Last Name:SCHWANDA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:W172N13113 DIVISION RD
Mailing Address - Street 2:
Mailing Address - City:GERMANTOWN
Mailing Address - State:WI
Mailing Address - Zip Code:53022-1414
Mailing Address - Country:US
Mailing Address - Phone:414-614-1128
Mailing Address - Fax:
Practice Address - Street 1:W172N13113 DIVISION RD
Practice Address - Street 2:
Practice Address - City:GERMANTOWN
Practice Address - State:WI
Practice Address - Zip Code:53022-1414
Practice Address - Country:US
Practice Address - Phone:414-614-1128
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-26
Last Update Date:2013-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI176714-30163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse