Provider Demographics
NPI:1851405237
Name:WELCH, MYRTLE RUTH (RN)
Entity Type:Individual
Prefix:
First Name:MYRTLE
Middle Name:RUTH
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 1:139 COUNTY ROAD 4946
Mailing Address - Street 2:
Mailing Address - City:ETOILE
Mailing Address - State:TX
Mailing Address - Zip Code:75944-7642
Mailing Address - Country:US
Mailing Address - Phone:936-633-2719
Mailing Address - Fax:936-633-2722
Practice Address - Street 1:1301 W FRANK AVE
Practice Address - Street 2:
Practice Address - City:LUFKIN
Practice Address - State:TX
Practice Address - Zip Code:75904-3305
Practice Address - Country:US
Practice Address - Phone:936-633-2719
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-19
Last Update Date:2008-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX226135163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse