Healthcare Provider Details

I. General information

NPI: 1578556940
Provider Name (Legal Business Name): ANNA M WELLS CSA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/31/2005
Last Update Date: 07/19/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1760 NICHOLASVILLE RD STE 604
LEXINGTON KY
40503-1471
US

IV. Provider business mailing address

1760 NICHOLASVILLE RD STE 604
LEXINGTON KY
40503-1471
US

V. Phone/Fax

Practice location:
  • Phone: 859-255-9059
  • Fax: 859-254-3112
Mailing address:
  • Phone: 859-255-9059
  • Fax: 859-254-3112

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246ZS0410X
TaxonomySurgical Technologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: