Healthcare Provider Details

I. General information

NPI: 1770911778
Provider Name (Legal Business Name): SHERISSE FATIMA WELCH FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/29/2013
Last Update Date: 08/17/2021
Certification Date: 08/17/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 AKRON GENERAL AVENUE
AKRON OH
44307
US

IV. Provider business mailing address

10462 TOLLAND DR
REMINDERVILLE OH
44202-8173
US

V. Phone/Fax

Practice location:
  • Phone: 330-810-0112
  • Fax:
Mailing address:
  • Phone: 216-870-7839
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAPRN.CNP.15147
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberCOA. 15147-NP
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: