Basic Information
| Provider Information | |||||||||
| NPI: | 1215676507 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | WELCH | ||||||||
| FirstName: | CAITLIN | ||||||||
| MiddleName: | MARY | ||||||||
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| OtherLastName: | WELCH | ||||||||
| OtherFirstName: | CAITLIN | ||||||||
| OtherMiddleName: | MARY | ||||||||
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| OtherLastNameType: | 5 | ||||||||
| Mailing Information | |||||||||
| Address1: | 1311 S NIELSON ST | ||||||||
| Address2: | |||||||||
| City: | GILBERT | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 852964265 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7086010773 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 6644 E BAYWOOD AVE | ||||||||
| Address2: | |||||||||
| City: | MESA | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 852061747 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4803212000 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/03/2022 | ||||||||
| LastUpdateDate: | 09/01/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 08/26/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 367500000X | 275469 | AZ | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Anesthetist, Certified Registered |
No ID Information.