MEDICARE: LAVERN NATASHA WELCOME

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	174400000X	Specialist	1320654	NY

General Provider Information

NPI Number	:	1609440734
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LAVERN NATASHA WELCOME

Provider Business Mailing Address
First Line	:	1580 DAHILL RD STE 2
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11204-3578
Country	:	US
Telephone Number	:	718-375-2505
Fax Number	:	718-375-2472

Provider Business Practice Location Address
First Line	:	1580 DAHILL RD STE 2
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11204-3578
Country	:	US
Telephone Number	:	718-375-2505
Fax Number	:	718-375-2472

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

Provider Enumeration Date	:	05/13/2021
Last Update Date	:	05/13/2021

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Directions to “ LAVERN NATASHA WELCOME ” Practice Location

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