Healthcare Provider Details

I. General information

NPI: 1184398810
Provider Name (Legal Business Name): ALISHA ROSE WELSH NP-C, NP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MISS ALISHA ROSE DAMATO

II. Dates (important events)

Enumeration Date: 08/05/2021
Last Update Date: 03/31/2023
Certification Date: 03/31/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3350 GRATIOT BLVD STE A
MARYSVILLE MI
48040-2121
US

IV. Provider business mailing address

3350 GRATIOT BLVD STE A
MARYSVILLE MI
48040-2121
US

V. Phone/Fax

Practice location:
  • Phone: 810-364-4000
  • Fax:
Mailing address:
  • Phone: 810-364-4000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number4704321814
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code163WG0000X
TaxonomyGeneral Practice Registered Nurse
License Number207Q00000X
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: