Provider Demographics
NPI:1922428267
Name:WELCH, MARCIA MADONNA
Entity Type:Individual
Prefix:
First Name:MARCIA
Middle Name:MADONNA
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 1:9670 MURIEL AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63114-2614
Mailing Address - Country:US
Mailing Address - Phone:314-687-7380
Mailing Address - Fax:
Practice Address - Street 1:9670 MURIEL AVE
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63114-2614
Practice Address - Country:US
Practice Address - Phone:314-687-7380
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-25
Last Update Date:2014-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO114312B376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide