Healthcare Provider Details

I. General information

NPI: 1235945809
Provider Name (Legal Business Name): DOLORES LOUELLA WELD RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/09/2024
Last Update Date: 12/09/2024
Certification Date: 12/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1211 E GUADALUPE RD
GILBERT AZ
85234-4889
US

IV. Provider business mailing address

1326 W CLEAR SPRING DR
GILBERT AZ
85233-6600
US

V. Phone/Fax

Practice location:
  • Phone: 480-892-2803
  • Fax:
Mailing address:
  • Phone: 619-252-4463
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WS0200X
TaxonomySchool Registered Nurse
License Number214276
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: