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NPI Code Detail

MEDICARE: LEANN JEAN WILLIS WELCH NP

MEDICARE: LEANN JEAN WILLIS WELCH NP
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
1363LF0000XFamily Nurse Practitioner200640863RNOR
2363LF0000XFamily Nurse Practitioner200650049NPOR

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
2107658OTHERORMEDICARE ID# PTAN

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1679523971
Entity Type Code : Individual
Provider Name (Legal Business Name) : LEANN JEAN WILLIS WELCH NP
Provider Business Mailing Address
First Line : 150 S WALL ST
Second Line :
City : COOS BAY
State : OR
Zip : 97420-3233
Country : US
Telephone Number : 541-435-7200
Fax Number : 541-888-0025
Provider Business Practice Location Address
First Line : 150 S WALL ST
Second Line :
City : COOS BAY
State : OR
Zip : 97420-3233
Country : US
Telephone Number : 541-435-7200
Fax Number : 541-888-0025
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/10/2006
Last Update Date : 07/11/2024

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