MEDICARE: AMBER MARIE WELLMAN PA-C

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	363AM0700X	Medical Physician Assistant	PA1394	OK

General Provider Information

NPI Number	:	1689776247
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMBER MARIE WELLMAN PA-C

Provider Business Mailing Address
First Line	:	3957 E COVELL RD
Second Line	:
City	:	EDMOND
State	:	OK
Zip	:	73034-6909
Country	:	US
Telephone Number	:	405-285-7246
Fax Number	:	405-285-7546

Provider Business Practice Location Address
First Line	:	3957 E COVELL RD
Second Line	:
City	:	EDMOND
State	:	OK
Zip	:	73034-6909
Country	:	US
Telephone Number	:	405-285-7246
Fax Number	:	405-285-7546

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

Provider Enumeration Date	:	09/03/2006
Last Update Date	:	10/04/2013

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