Healthcare Provider Details

I. General information

NPI: 1730497595
Provider Name (Legal Business Name): JENNIFER ANN WELCH CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JENNIFER ANN RYBARCZYK

II. Dates (important events)

Enumeration Date: 09/15/2010
Last Update Date: 12/22/2020
Certification Date: 12/22/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18181 OAKWOOD BLVD STE 411
DEARBORN MI
48124-4082
US

IV. Provider business mailing address

401 S BALLENGER HWY
FLINT MI
48532-3638
US

V. Phone/Fax

Practice location:
  • Phone: 313-438-7373
  • Fax: 313-438-7375
Mailing address:
  • Phone: 810-342-5700
  • Fax: 810-342-5545

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number4704248435
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: