Provider Demographics
NPI:1457969461
Name:WELCH, MIRANDA (CPM)
Entity Type:Individual
Prefix:
First Name:MIRANDA
Middle Name:
Last Name:WELCH
Suffix:
Gender:F
Credentials:CPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2414 E MIFFLIN ST
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53704-4965
Mailing Address - Country:US
Mailing Address - Phone:608-224-9788
Mailing Address - Fax:833-603-1294
Practice Address - Street 1:2414 E MIFFLIN ST
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53704-4965
Practice Address - Country:US
Practice Address - Phone:608-224-9788
Practice Address - Fax:833-603-1294
Is Sole Proprietor?:No
Enumeration Date:2020-07-15
Last Update Date:2020-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife