Healthcare Provider Details

I. General information

NPI: 1841592276
Provider Name (Legal Business Name): QUALA A WELLS-MCGHEE FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: QUALA A MCGHEE

II. Dates (important events)

Enumeration Date: 11/17/2010
Last Update Date: 10/16/2023
Certification Date: 08/04/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 MERCY CIRCLE
CAMP PENDLETON CA
92055
US

IV. Provider business mailing address

34985 ALLIUM LN
WINCHESTER CA
92596-8961
US

V. Phone/Fax

Practice location:
  • Phone: 773-425-3304
  • Fax:
Mailing address:
  • Phone: 951-599-4861
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1710I1002X
TaxonomyIndependent Duty Corpsman
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number95015032
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: