Healthcare Provider Details

I. General information

NPI: 1356307540
Provider Name (Legal Business Name): GLADE C WELKER NP-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/25/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

52 N 1100 E
AMERICAN FORK UT
84003-2952
US

IV. Provider business mailing address

52 N 1100 E
AMERICAN FORK UT
84003-2952
US

V. Phone/Fax

Practice location:
  • Phone: 801-763-0801
  • Fax: 801-763-0903
Mailing address:
  • Phone: 801-763-0801
  • Fax: 801-763-0903

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number329747-4405
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: