Healthcare Provider Details

I. General information

NPI: 1083899678
Provider Name (Legal Business Name): DIANNE WELLS N.P.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/02/2008
Last Update Date: 10/05/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5 INDUSTRIAL DR SUITE 100
MASHPEE MA
02649-3464
US

IV. Provider business mailing address

PO BOX 1500
MASHPEE MA
02649-1500
US

V. Phone/Fax

Practice location:
  • Phone: 508-477-4282
  • Fax: 508-539-6134
Mailing address:
  • Phone: 508-477-4282
  • Fax: 508-539-6134

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number141601
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: