MEDICARE: AYTEN W WELCH CRNA

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	367500000X	Certified Registered Nurse Anesthetist	209001496	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	041915	OTHER		CCNA CERTIFICATION
2	041192912	OTHER		RN LICENSE

General Provider Information

NPI Number	:	1366404741
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AYTEN W WELCH CRNA

Provider Business Mailing Address
First Line	:	12251 S 80TH AVE
Second Line	:
City	:	PALOS HEIGHTS
State	:	IL
Zip	:	60463-1290
Country	:	US
Telephone Number	:	708-923-3936
Fax Number	:	708-923-8848

Provider Business Practice Location Address
First Line	:	12251 S 80TH AVE
Second Line	:
City	:	PALOS HEIGHTS
State	:	IL
Zip	:	60463-1290
Country	:	US
Telephone Number	:	708-923-3936
Fax Number	:	708-923-8848

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

Provider Enumeration Date	:	04/03/2006
Last Update Date	:	12/15/2022

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