Healthcare Provider Details

I. General information

NPI: 1194969832
Provider Name (Legal Business Name): DIANE KEEGAN WELLS RN, CPNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/24/2009
Last Update Date: 04/24/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22 S GREENE ST ROOM N5E16
BALTIMORE MD
21201-1544
US

IV. Provider business mailing address

22 S GREENE ST ROOM N5E16
BALTIMORE MD
21201-1544
US

V. Phone/Fax

Practice location:
  • Phone: 410-328-2808
  • Fax: 410-328-0571
Mailing address:
  • Phone: 410-328-2808
  • Fax: 410-328-0571

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberR091240
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: