MEDICARE: NICOLE RENEE WELLS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101Y00000X	Counselor

General Provider Information

NPI Number	:	1144595505
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NICOLE RENEE WELLS

Provider Business Mailing Address
First Line	:	805 NW 120TH TER
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73114-7207
Country	:	US
Telephone Number	:	405-503-5066
Fax Number	:

Provider Business Practice Location Address
First Line	:	805 NW 120TH TER
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73114-7207
Country	:	US
Telephone Number	:	405-503-5066
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/19/2012
Last Update Date	:	03/19/2012

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Directions to “ NICOLE RENEE WELLS ” Practice Location

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