Provider Demographics
NPI:1942455258
Name:WELCH, MOLLY KATHLEEN (RN, CNP)
Entity Type:Individual
Prefix:
First Name:MOLLY
Middle Name:KATHLEEN
Last Name:WELCH
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Gender:F
Credentials:RN, CNP
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Mailing Address - Street 1:1200 6TH AVE N
Mailing Address - Street 2:CENTRACARE CLINIC
Mailing Address - City:SAINT CLOUD
Mailing Address - State:MN
Mailing Address - Zip Code:56303-2735
Mailing Address - Country:US
Mailing Address - Phone:701-234-5997
Mailing Address - Fax:701-234-7194
Practice Address - Street 1:1200 6TH AVE N
Practice Address - Street 2:CENTRACARE CLINIC
Practice Address - City:SAINT CLOUD
Practice Address - State:MN
Practice Address - Zip Code:56303-2735
Practice Address - Country:US
Practice Address - Phone:701-234-5997
Practice Address - Fax:701-234-7194
Is Sole Proprietor?:No
Enumeration Date:2008-12-01
Last Update Date:2013-07-26
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NDR29825363L00000X
MNR162736-92080N0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080N0001XAllopathic & Osteopathic PhysiciansPediatricsNeonatal-Perinatal Medicine
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner