Healthcare Provider Details

I. General information

NPI: 1861829186
Provider Name (Legal Business Name): LORI ANN WELLS ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/01/2013
Last Update Date: 10/01/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

304 FRANKLIN ST
KEOSAUQUA IA
52565-1164
US

IV. Provider business mailing address

18001 CHESTNUT AVE
DOUDS IA
52551-8077
US

V. Phone/Fax

Practice location:
  • Phone: 319-293-3171
  • Fax:
Mailing address:
  • Phone: 641-936-7161
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number084123
License Number StateIA
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberA084123
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: