Healthcare Provider Details

I. General information

NPI: 1295275568
Provider Name (Legal Business Name): CHRISTOPHER WELSH FNP-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/06/2017
Last Update Date: 03/05/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1840 E WARNER RD STE 120
TEMPE AZ
85284-3445
US

IV. Provider business mailing address

860 W MOUNTAIN VIEW DR
MESA AZ
85201-3125
US

V. Phone/Fax

Practice location:
  • Phone: 480-848-5411
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP10335
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN184359
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: