Healthcare Provider Details

I. General information

NPI: 1255144093
Provider Name (Legal Business Name): MS. LAUREL HENRICKSON WELSH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/27/2025
Last Update Date: 01/27/2025
Certification Date: 01/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8213 BURLEIGH RD
GRAND BLANC MI
48439-9764
US

IV. Provider business mailing address

PO BOX 25
ATLAS MI
48411-0025
US

V. Phone/Fax

Practice location:
  • Phone: 810-516-5828
  • Fax:
Mailing address:
  • Phone: 810-516-5828
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133NN1002X
TaxonomyNutrition Education Nutritionist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: