Provider Demographics
NPI:1992896054
Name:WELCH, KAREN TERESA (ANP)
Entity type:Individual
Prefix:MRS
First Name:KAREN
Middle Name:TERESA
Last Name:WELCH
Suffix:
Gender:F
Credentials:ANP
Other - Prefix:
Other - First Name:KAREN
Other - Middle Name:TERESA
Other - Last Name:PETRINO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3 GROVE PL
Mailing Address - Street 2:
Mailing Address - City:MELROSE
Mailing Address - State:MA
Mailing Address - Zip Code:02176-4617
Mailing Address - Country:US
Mailing Address - Phone:617-531-5738
Mailing Address - Fax:
Practice Address - Street 1:4 VIRGINIA LANE
Practice Address - Street 2:DAF MEDICAL ASSOCIATES INC
Practice Address - City:STONEHAM
Practice Address - State:MA
Practice Address - Zip Code:02180
Practice Address - Country:US
Practice Address - Phone:781-438-4625
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-27
Last Update Date:2012-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA139914163W00000X, 363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
MANP9607OtherBCBS
MA0710130Medicaid
MAP0039016OtherMEDICARE RR
MA0000036Medicare PIN
MANP9607OtherBCBS