Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LN0005X | Nurse Practitioner - Neonatal (Critical Care) | 041385273 | IL |
NPI | 1275958373 |
---|---|
Provider Name | Brittany Welch |
First Address | Peoria, IL 61637-0001 |
Second Address | Peoria, IL 61637-0001 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/02/2014 |
Last Update Date | 26/02/2014 |