Provider Demographics
NPI:1982718938
Name:WELTY, SHARON K (APN MSNCS)
Entity Type:Individual
Prefix:MRS
First Name:SHARON
Middle Name:K
Last Name:WELTY
Suffix:
Gender:F
Credentials:APN MSNCS
Other - Prefix:MISS
Other - First Name:SHARON
Other - Middle Name:K
Other - Last Name:PRATHER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1200 N EAST ST
Mailing Address - Street 2:WEBER MEDICAL CLINIC LTD
Mailing Address - City:OLNEY
Mailing Address - State:IL
Mailing Address - Zip Code:62450-2499
Mailing Address - Country:US
Mailing Address - Phone:618-395-5222
Mailing Address - Fax:618-395-8552
Practice Address - Street 1:1200 N EAST ST
Practice Address - Street 2:
Practice Address - City:OLNEY
Practice Address - State:IL
Practice Address - Zip Code:62450-2499
Practice Address - Country:US
Practice Address - Phone:618-395-5222
Practice Address - Fax:618-395-8552
Is Sole Proprietor?:No
Enumeration Date:2006-08-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL068527OtherHEALTH ALLIANCE
IL068527OtherHEALTH ALLIANCE
IL210225Medicare ID - Type Unspecified