Healthcare Provider Details

I. General information

NPI: 1053669184
Provider Name (Legal Business Name): STEPHANIE ANN WELCH APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/21/2012
Last Update Date: 03/05/2024
Certification Date: 03/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21000 TORRENCE CHAPEL RD STE 103B
CORNELIUS NC
28031-6850
US

IV. Provider business mailing address

21000 TORRENCE CHAPEL RD STE 103B
CORNELIUS NC
28031-6850
US

V. Phone/Fax

Practice location:
  • Phone: 704-741-1911
  • Fax:
Mailing address:
  • Phone: 704-741-1911
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number5008115
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: