Healthcare Provider Details

I. General information

NPI: 1376228304
Provider Name (Legal Business Name): JAMIE MARIE WELLS DNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/19/2023
Last Update Date: 10/06/2026
Certification Date: 10/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7910 FROST ST STE 400
SAN DIEGO CA
92123-2753
US

IV. Provider business mailing address

7910 FROST ST STE 400
SAN DIEGO CA
92123-2753
US

V. Phone/Fax

Practice location:
  • Phone: 858-495-0500
  • Fax: 858-560-4279
Mailing address:
  • Phone: 661-350-6088
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number95039926
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: