Provider Demographics
NPI:1972606069
Name:WELSH, STEPHANIE L (CNM)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:L
Last Name:WELSH
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21 LEDGEBROOK DR
Mailing Address - Street 2:
Mailing Address - City:MANSFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06250
Mailing Address - Country:US
Mailing Address - Phone:860-450-7227
Mailing Address - Fax:860-450-7231
Practice Address - Street 1:21 LEDGEBROOK DR
Practice Address - Street 2:
Practice Address - City:MANSFIELD
Practice Address - State:CT
Practice Address - Zip Code:06250
Practice Address - Country:US
Practice Address - Phone:860-450-7227
Practice Address - Fax:860-450-7231
Is Sole Proprietor?:No
Enumeration Date:2006-09-06
Last Update Date:2012-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000241367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT004229523Medicaid
420000187Medicare ID - Type Unspecified
CT004229523Medicaid