Healthcare Provider Details

I. General information

NPI: 1023531571
Provider Name (Legal Business Name): CRISTA C WELLS DNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CRISTA C PRATES DNP

II. Dates (important events)

Enumeration Date: 07/17/2017
Last Update Date: 09/22/2026
Certification Date: 09/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

65 WATER ST
BLUE HILL ME
04614-5231
US

IV. Provider business mailing address

PO BOX 40409
BELFAST ME
04915-1255
US

V. Phone/Fax

Practice location:
  • Phone: 207-374-2311
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number61888
License Number StateCT
# 2
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number7283
License Number StateCT
# 3
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberCNP251158
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: