Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 224P00000X | Prosthetist |
NPI | 1023576972 |
---|---|
Provider Name | Ms. Synterika Shanta Welch |
First Address | Coldwater, MS 38618-3779 |
Second Address | Olive Branch, MS 38654-4472 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 11/03/2019 |
Last Update Date | 11/03/2019 |