Healthcare Provider Details

I. General information

NPI: 1093084857
Provider Name (Legal Business Name): MIRANDA WELCH D.A.O.M, L.AC,
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/23/2011
Last Update Date: 05/07/2026
Certification Date: 05/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

133 WNUK RD
WHITE SALMON WA
98672-8428
US

IV. Provider business mailing address

133 WNUK RD
WHITE SALMON WA
98672-8428
US

V. Phone/Fax

Practice location:
  • Phone: 503-740-4772
  • Fax: 509-588-7072
Mailing address:
  • Phone: 503-740-4772
  • Fax: 509-588-7072

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number60560608
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: