Doctor Name: | CARRIE WELTY |
NPI Number: | 1043625494 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | ARNP |
License Number: | AP60475291 |
Business Practice Address: | 2555 Marvin Rd Ne Pmg Sw Wa Hawks Prairie Fm Lacey, WA - 985163138 |
Business Phone Number: | 3604134200 |
Business Fax Number: | |
Mailing Address: | Po Box 3360, PORTLAND |
State: | OR |
Postal Code: | 972083360 |
Phone Number: | 8667472455 |
Fax Number: | |
NPI Enumeration Date: | 06/24/2014 |
NPI Last Update Date: | 06/24/2014 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363LF0000X |
License Number: | AP60475291 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | WA |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Nurse Practitioner |
Taxonomy Specialization: | Family |
Taxonomy Definition: |