Healthcare Provider Details

I. General information

NPI: 1154434512
Provider Name (Legal Business Name): AMY SUE WELCH CFNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/17/2006
Last Update Date: 03/21/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

44525 MARIETTA RD
CALDWELL OH
43724-9209
US

IV. Provider business mailing address

44525 MARIETTA RD
CALDWELL OH
43724-9209
US

V. Phone/Fax

Practice location:
  • Phone: 740-732-6851
  • Fax: 740-732-7425
Mailing address:
  • Phone: 740-732-6851
  • Fax: 740-732-4029

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberNP07624
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: