Healthcare Provider Details

I. General information

NPI: 1275224040
Provider Name (Legal Business Name): COLLETTE RENEE WELCH CPRS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/15/2023
Last Update Date: 05/15/2023
Certification Date: 05/15/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 WALNUT ST
GREENVILLE OH
45331-1944
US

IV. Provider business mailing address

1445 HUNTER CT
TROY OH
45373-6607
US

V. Phone/Fax

Practice location:
  • Phone: 937-548-6842
  • Fax:
Mailing address:
  • Phone: 937-524-8376
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License NumberAPS.004136
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: