MEDICARE: MR. WILLIAM S. WELTE NMW

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	367A00000X	Advanced Practice Midwife	NM1074	CA

General Provider Information

NPI Number	:	1235313396
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. WILLIAM S. WELTE NMW

Provider Business Mailing Address
First Line	:	4343 YAQUI PASS ROAD
Second Line	:
City	:	BORREGO SPRINGS
State	:	CA
Zip	:	92004-2369
Country	:	US
Telephone Number	:	760-767-5051
Fax Number	:	760-767-4552

Provider Business Practice Location Address
First Line	:	4343 YAQUI PASS ROAD
Second Line	:
City	:	BORREGO SPRINGS
State	:	CA
Zip	:	92004-2369
Country	:	US
Telephone Number	:	760-767-5051
Fax Number	:	760-767-4552

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

Provider Enumeration Date	:	12/26/2007
Last Update Date	:	01/04/2012

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