MEDICARE: CALEB T WELCH

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163W00000X	Registered Nurse	28245597A	IN

General Provider Information

NPI Number	:	1124613229
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CALEB T WELCH

Provider Business Mailing Address
First Line	:	9016 ASHFORD CASTLE DR APT 512
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46250-5621
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	9016 ASHFORD CASTLE DR APT 512
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46250-5621
Country	:	US
Telephone Number	:	260-494-7542
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/02/2021
Last Update Date	:	03/02/2021

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