Healthcare Provider Details

I. General information

NPI: 1740376227
Provider Name (Legal Business Name): ANNE MARIE WELLS PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/04/2006
Last Update Date: 09/13/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2740 OAK RIDGE CT STE 304
FORT MYERS FL
33901-9371
US

IV. Provider business mailing address

2740 OAK RIDGE CT STE 304
FORT MYERS FL
33901-9371
US

V. Phone/Fax

Practice location:
  • Phone: 239-368-3708
  • Fax: 239-368-3708
Mailing address:
  • Phone: 239-368-3708
  • Fax: 239-368-3708

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPY5593
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPY5593
License Number StateFL
# 3
Primary TaxonomyY
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License NumberPY5593
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: