Provider Demographics
NPI:1952050262
Name:WELCH, BREYAUNA LASHA (RN)
Entity Type:Individual
Prefix:
First Name:BREYAUNA
Middle Name:LASHA
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 1:8250 BASH ST STE 23
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46250-1792
Mailing Address - Country:US
Mailing Address - Phone:317-527-1047
Mailing Address - Fax:
Practice Address - Street 1:8250 BASH ST STE 23
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46250-1792
Practice Address - Country:US
Practice Address - Phone:317-527-1047
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-22
Last Update Date:2022-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN28205246A163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse