Provider Demographics
NPI:1023131562
Name:WELCH, LISA J (LPN)
Entity type:Individual
Prefix:MRS
First Name:LISA
Middle Name:J
Last Name:WELCH
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:224 W OAK ST
Mailing Address - Street 2:
Mailing Address - City:HAZLETON
Mailing Address - State:PA
Mailing Address - Zip Code:18201-5839
Mailing Address - Country:US
Mailing Address - Phone:570-455-6583
Mailing Address - Fax:
Practice Address - Street 1:224 W OAK ST
Practice Address - Street 2:
Practice Address - City:HAZLETON
Practice Address - State:PA
Practice Address - Zip Code:18201-5839
Practice Address - Country:US
Practice Address - Phone:570-455-6583
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPN107757L164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse