Provider Demographics
NPI:1376425264
Name:WELCH, GINA SIMUNOVICH (STUDENT)
Entity type:Individual
Prefix:
First Name:GINA
Middle Name:SIMUNOVICH
Last Name:WELCH
Suffix:
Gender:X
Credentials:STUDENT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2431 RIVER RD
Mailing Address - Street 2:
Mailing Address - City:MISSOULA
Mailing Address - State:MT
Mailing Address - Zip Code:59804-1239
Mailing Address - Country:US
Mailing Address - Phone:406-361-5093
Mailing Address - Fax:
Practice Address - Street 1:2431 RIVER RD
Practice Address - Street 2:
Practice Address - City:MISSOULA
Practice Address - State:MT
Practice Address - Zip Code:59804-1239
Practice Address - Country:US
Practice Address - Phone:406-361-5093
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-07-22
Last Update Date:2025-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program