Individual
MRS. SAMANTHA DANIELLE WELCH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP
Contact information
Practice address
500 MAIN ST, CABOOL, MO 65689-8104
(417) 962-3015
(417) 962-5240
Mailing address
94 COUNTY ROAD 4230, SALEM, MO 65560-8129
(573) 247-8980
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
2020008394
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
26D0679044
CLIA LFC
MO
01
—
26D0859759
CLIA CMC
MO
01
—
26D2006074
CLIA MG
MO
01
—
26D2178130
CLIA FHC
MO
05
—
420081939
—
MO
Enumeration date
03/10/2020
Last updated
04/29/2020
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