Healthcare Provider Details

I. General information

NPI: 1215521133
Provider Name (Legal Business Name): CATHY DORRIS WELLS RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/22/2021
Last Update Date: 09/16/2021
Certification Date: 09/16/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1650 COCHRAN CIRCLE
COLORADO SPRINGS CO
80913-8091
US

IV. Provider business mailing address

375 W KATHY LN
COLORADO SPRINGS CO
80926-9516
US

V. Phone/Fax

Practice location:
  • Phone: 719-524-3783
  • Fax:
Mailing address:
  • Phone: 719-671-9665
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN.0112736
License Number StateCO
# 2
Primary TaxonomyY
Taxonomy Code163WC0400X
TaxonomyCase Management Registered Nurse
License NumberRN.0112736
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: