Individual
LAUREL LYNN WELTY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
APN
Contact information
Practice address
722 N 10TH ST, MONMOUTH, IL 61462-1430
(317) 473-3587
Mailing address
722 N 10TH ST, MONMOUTH, IL 61462-1430
(317) 473-3587
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
105881
IA
363LF0000X
Family Nurse Practitioner
141990-7545
LA
363LF0000X
Family Nurse Practitioner
28197693A
IN
363LF0000X
Family Nurse Practitioner
829265
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1144461757
WELLMARK
IA
05
—
1144461757
—
IA
Enumeration date
03/11/2009
Last updated
01/12/2015
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