Provider Demographics
NPI:1972288819
Name:WELTER, JOHN
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:
Last Name:WELTER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:820 BROCKTON LN N
Mailing Address - Street 2:
Mailing Address - City:PLYMOUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55447-3343
Mailing Address - Country:US
Mailing Address - Phone:619-971-2356
Mailing Address - Fax:
Practice Address - Street 1:820 BROCKTON LN N
Practice Address - Street 2:
Practice Address - City:PLYMOUTH
Practice Address - State:MN
Practice Address - Zip Code:55447-3343
Practice Address - Country:US
Practice Address - Phone:619-971-2356
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-19
Last Update Date:2023-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program