Basic Information
| Provider Information | |||||||||
| NPI: | 1235397738 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | WELCH | ||||||||
| FirstName: | RUSSELL | ||||||||
| MiddleName: | LEE | ||||||||
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| Credential: | NP-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1200 N. ELM ST | ||||||||
| Address2: | STE 200 | ||||||||
| City: | GREENSBORO | ||||||||
| State: | NC | ||||||||
| PostalCode: | 27401 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3362972271 | ||||||||
| FaxNumber: | 3362972282 | ||||||||
| Practice Location | |||||||||
| Address1: | 510 N.ELAM AVE | ||||||||
| Address2: | STE 302 | ||||||||
| City: | GREENSBORO | ||||||||
| State: | NC | ||||||||
| PostalCode: | 27403 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3362972271 | ||||||||
| FaxNumber: | 3362972282 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/30/2008 | ||||||||
| LastUpdateDate: | 10/22/2012 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363L00000X | 138254 | NC | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |
No ID Information.