Basic Information
| Provider Information | |||||||||
| NPI: | 1871750901 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | WELKE | ||||||||
| FirstName: | LYNNE | ||||||||
| MiddleName: | C | ||||||||
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| Credential: | RN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 9808 VENICE BLVD | ||||||||
| Address2: | 700 | ||||||||
| City: | CULVER CITY | ||||||||
| State: | CA | ||||||||
| PostalCode: | 902322732 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3109453350 | ||||||||
| FaxNumber: | 3108407023 | ||||||||
| Practice Location | |||||||||
| Address1: | 524 W VISTA WAY | ||||||||
| Address2: | |||||||||
| City: | VISTA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 920835704 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7607581150 | ||||||||
| FaxNumber: | 7607581808 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/16/2008 | ||||||||
| LastUpdateDate: | 06/20/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163WP0809X | 209176 | CA | Y | Nursing Service Providers | Registered Nurse | Psych/Mental Health, Adult |
No ID Information.