Healthcare Provider Details

I. General information

NPI: 1477517407
Provider Name (Legal Business Name): SHEILA WELLS APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/14/2006
Last Update Date: 06/12/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

340 MAIN ST SUITE 510
WORCESTER MA
01608-1604
US

IV. Provider business mailing address

340 MAIN ST SUITE 510
WORCESTER MA
01608-1604
US

V. Phone/Fax

Practice location:
  • Phone: 508-752-4665
  • Fax: 508-752-0947
Mailing address:
  • Phone: 508-752-4665
  • Fax: 508-752-0947

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0807X
TaxonomyChild & Adolescent Psychiatric/Mental Health Registered Nurse
License Number174905
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: