Provider Demographics
NPI:1245500610
Name:WELTI, MARY (ANP-C)
Entity type:Individual
Prefix:MRS
First Name:MARY
Middle Name:
Last Name:WELTI
Suffix:
Gender:F
Credentials:ANP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12504 SE 93RD COURT RD
Mailing Address - Street 2:
Mailing Address - City:SUMMERFIELD
Mailing Address - State:FL
Mailing Address - Zip Code:34491-9722
Mailing Address - Country:US
Mailing Address - Phone:312-371-4513
Mailing Address - Fax:
Practice Address - Street 1:12504 SE 93RD COURT RD
Practice Address - Street 2:
Practice Address - City:SUMMERFIELD
Practice Address - State:FL
Practice Address - Zip Code:34491-9722
Practice Address - Country:US
Practice Address - Phone:312-371-4513
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-03
Last Update Date:2025-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209.009155363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health