Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223G0001X | General Practice | 11308 | MN |
Y | 213EG0000X | General Practice | 11308 | MN |
N | 122400000X | Denturist | D11308 | MN |
NPI | 1255405478 |
---|---|
Provider Name | Mrs. Kim M Welch |
First Address | Sartell, MN 56377 |
Second Address | Sartell, MN 56377 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/11/2006 |
Last Update Date | 17/09/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
121220600 | (05) | MN |