Basic Information
| Provider Information | |||||||||
| NPI: | 1912159658 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | WELCH | ||||||||
| FirstName: | SHANDA | ||||||||
| MiddleName: | H | ||||||||
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| Credential: | CRNA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5350 FRANTZ RD | ||||||||
| Address2: | |||||||||
| City: | DUBLIN | ||||||||
| State: | OH | ||||||||
| PostalCode: | 430164259 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6145446356 | ||||||||
| FaxNumber: | 6145446350 | ||||||||
| Practice Location | |||||||||
| Address1: | 111 S GRANT AVE | ||||||||
| Address2: | 3RD FL | ||||||||
| City: | COLUMBUS | ||||||||
| State: | OH | ||||||||
| PostalCode: | 432154701 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6145669983 | ||||||||
| FaxNumber: | 6145669503 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/14/2008 | ||||||||
| LastUpdateDate: | 10/14/2008 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 367500000X | NA-10247 | OH | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Anesthetist, Certified Registered |
No ID Information.