Healthcare Provider Details

I. General information

NPI: 1699144303
Provider Name (Legal Business Name): CHRISTINA LYNN WELLS FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/23/2015
Last Update Date: 06/20/2025
Certification Date: 12/28/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1418 CROSS ST DIV WUPI HEMATOLOGY, STE 180
SHILOH IL
62269-2914
US

IV. Provider business mailing address

PO BOX 7412011
CHICAGO IL
60674-2011
US

V. Phone/Fax

Practice location:
  • Phone: 314-362-7216
  • Fax: 314-696-1391
Mailing address:
  • Phone: 314-362-7216
  • Fax: 314-696-1391

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number209023830
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: