Provider Demographics
NPI:1184398810
Name:WELSH, ALISHA ROSE (NP-C, NP-BC)
Entity type:Individual
Prefix:MRS
First Name:ALISHA
Middle Name:ROSE
Last Name:WELSH
Suffix:
Gender:F
Credentials:NP-C, NP-BC
Other - Prefix:MISS
Other - First Name:ALISHA
Other - Middle Name:ROSE
Other - Last Name:DAMATO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3350 GRATIOT BLVD STE A
Mailing Address - Street 2:
Mailing Address - City:MARYSVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:48040-2121
Mailing Address - Country:US
Mailing Address - Phone:810-364-4000
Mailing Address - Fax:
Practice Address - Street 1:3350 GRATIOT BLVD STE A
Practice Address - Street 2:
Practice Address - City:MARYSVILLE
Practice Address - State:MI
Practice Address - Zip Code:48040-2121
Practice Address - Country:US
Practice Address - Phone:810-364-4000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-05
Last Update Date:2023-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI207Q00000X163WG0000X
MI4704321814363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice