1417944372 NPI number — MARY BYRNE WELCH RN FNP, AOCN

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1417944372 NPI number — MARY BYRNE WELCH RN FNP, AOCN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WELCH
Provider First Name:
MARY
Provider Middle Name:
BYRNE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
RN FNP, AOCN
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
BYRNE
Provider Other First Name:
MARY
Provider Other Middle Name:
CATHERINE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
RN, MS, FNP, AOCN
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1417944372
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/02/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2810 LONG BEACH BLVD
Provider Second Line Business Mailing Address:
TODD CANCER INSTITUTE AT LONG BEACH MEMORIAL
Provider Business Mailing Address City Name:
LONG BEACH
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
90806
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
562-933-0961
Provider Business Mailing Address Fax Number:
560-933-0960

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2810 LONG BEACH BL
Provider Second Line Business Practice Location Address:
TODD CANCER INSTITUTE AT LONG BEACH MEMORIAL
Provider Business Practice Location Address City Name:
LONG BEACH
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90806
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
562-933-0961
Provider Business Practice Location Address Fax Number:
560-933-0960
Provider Enumeration Date:
10/05/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363L00000X , with the licence number:  RN479278 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 500022897 . This is a "RAILROAD MEDICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: NPO114960 . This is a "BLUE SHIELD" identifier . This identifiers is of the category "OTHER".




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