Provider Demographics
NPI:1003516089
Name:WELCH, ELAINE SUZANNE (APRN)
Entity type:Individual
Prefix:MRS
First Name:ELAINE
Middle Name:SUZANNE
Last Name:WELCH
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Mailing Address - Street 1:9517 EDDIE AND PARK RD
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63126-2835
Mailing Address - Country:US
Mailing Address - Phone:314-265-6166
Mailing Address - Fax:
Practice Address - Street 1:10004 KENNERLY RD STE 115A
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63128-5106
Practice Address - Country:US
Practice Address - Phone:314-525-1538
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-07
Last Update Date:2023-07-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MO2023009848363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care