=====================================================
General NPI Number Information
=====================================================
NPI Number | 1780284307
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | CATY WELCH-RAAB LVN
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/01/2020
-----------------------------------------------------
Last Update Date | 11/01/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 717 DOGWOOD ST
-----------------------------------------------------
City | ROBINSON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 76706-5213
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 254-252-7099
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 717 DOGWOOD ST
-----------------------------------------------------
City | ROBINSON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 76706-5213
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 254-252-7099
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 164X00000X
-----------------------------------------------------
Taxonomy Name | Licensed Vocational Nurse
-----------------------------------------------------
License Number | 339220
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------