Individual
LEANN JEAN WILLIS WELCH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
150 S WALL ST, COOS BAY, OR 97420-3233
(541) 435-7200
(541) 888-0025
Mailing address
150 S WALL ST, COOS BAY, OR 97420-3233
(541) 435-7200
(541) 888-0025
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
200640863RN
OR
363LF0000X
Family Nurse Practitioner
Primary
200650049NP
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
107658
MEDICARE ID# PTAN
OR
05
—
165031
—
OR
05
—
240703
—
OR
01
—
MW1412927
CSR
OR
Enumeration date
05/10/2006
Last updated
07/11/2024
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