Provider Demographics
NPI:1912329814
Name:WELCH, TIANISHA (LPN)
Entity type:Individual
Prefix:MRS
First Name:TIANISHA
Middle Name:
Last Name:WELCH
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:98 W HIGH TER
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14619-1833
Mailing Address - Country:US
Mailing Address - Phone:585-454-6521
Mailing Address - Fax:
Practice Address - Street 1:98 W HIGH TER
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14619-1833
Practice Address - Country:US
Practice Address - Phone:585-454-6521
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-10
Last Update Date:2014-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY311079164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse