Healthcare Provider Details

I. General information

NPI: 1891978003
Provider Name (Legal Business Name): LYNDA A WELCH RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/11/2007
Last Update Date: 10/27/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13101 ALLEN RD
SOUTHGATE MI
48195-2216
US

IV. Provider business mailing address

13101 ALLEN RD
SOUTHGATE MI
48195-2216
US

V. Phone/Fax

Practice location:
  • Phone: 734-785-7700
  • Fax: 734-287-1661
Mailing address:
  • Phone: 734-785-7700
  • Fax: 734-287-1661

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0809X
TaxonomyAdult Psychiatric/Mental Health Registered Nurse
License Number4704186950
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: