Healthcare Provider Details

I. General information

NPI: 1972606069
Provider Name (Legal Business Name): STEPHANIE L WELSH CNM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/06/2006
Last Update Date: 05/24/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21 LEDGEBROOK DR
MANSFIELD CT
06250
US

IV. Provider business mailing address

21 LEDGEBROOK DR
MANSFIELD CT
06250
US

V. Phone/Fax

Practice location:
  • Phone: 860-450-7227
  • Fax: 860-450-7231
Mailing address:
  • Phone: 860-450-7227
  • Fax: 860-450-7231

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number000241
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: