Provider Demographics
NPI:1649579624
Name:WELCH, CLAUDETTE (NURSE)
Entity Type:Individual
Prefix:MRS
First Name:CLAUDETTE
Middle Name:
Last Name:WELCH
Suffix:
Gender:F
Credentials:NURSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:412 3RD ST
Mailing Address - Street 2:
Mailing Address - City:GREENPORT
Mailing Address - State:NY
Mailing Address - Zip Code:11944-1314
Mailing Address - Country:US
Mailing Address - Phone:361-477-4921
Mailing Address - Fax:
Practice Address - Street 1:412 3RD ST
Practice Address - Street 2:
Practice Address - City:GREENPORT
Practice Address - State:NY
Practice Address - Zip Code:11944-1314
Practice Address - Country:US
Practice Address - Phone:361-477-4921
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-16
Last Update Date:2011-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY220023164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse