MEDICARE: KATHERINE M 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	172A00000X	Driver	C5776766	CA

General Provider Information

NPI Number	:	1396556502
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATHERINE M WELCH

Provider Business Mailing Address
First Line	:	PO BOX 844
Second Line	:
City	:	MOUNTAIN RANCH
State	:	CA
Zip	:	95246-0844
Country	:	US
Telephone Number	:	669-639-0704
Fax Number	:

Provider Business Practice Location Address
First Line	:	1475 RAILROAD FLAT RD
Second Line	:	6
City	:	MOKELUMNE HILL
State	:	CA
Zip	:	95245
Country	:	US
Telephone Number	:	209-897-0603
Fax Number	:

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

Provider Enumeration Date	:	01/16/2025
Last Update Date	:	01/16/2025

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