Provider Demographics
NPI:1366911513
Name:WELSHMAN, GLORIA PATRICIA (LPN)
Entity type:Individual
Prefix:
First Name:GLORIA
Middle Name:PATRICIA
Last Name:WELSHMAN
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 1:291 EASTCHESTER RD
Mailing Address - Street 2:
Mailing Address - City:NEW ROCHELLE
Mailing Address - State:NY
Mailing Address - Zip Code:10801-1001
Mailing Address - Country:US
Mailing Address - Phone:914-224-5034
Mailing Address - Fax:203-588-9881
Practice Address - Street 1:1425 BEDFORD ST APT 10E
Practice Address - Street 2:
Practice Address - City:STAMFORD
Practice Address - State:CT
Practice Address - Zip Code:06905-5234
Practice Address - Country:US
Practice Address - Phone:914-224-5034
Practice Address - Fax:203-588-9881
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-16
Last Update Date:2018-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT41948164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes164W00000XNursing Service ProvidersLicensed Practical NurseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT600890004366971101Medicaid