Healthcare Provider Details

I. General information

NPI: 1730136888
Provider Name (Legal Business Name): AMY T WELLS D.P.M.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/27/2006
Last Update Date: 01/19/2024
Certification Date: 01/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

594 RIVER RD
GREENE ME
04236-4103
US

IV. Provider business mailing address

PO BOX 718
GREENE ME
04236-0718
US

V. Phone/Fax

Practice location:
  • Phone: 207-783-7800
  • Fax: 207-783-7833
Mailing address:
  • Phone: 207-783-7800
  • Fax: 207-783-7833

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License NumberPOD192
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: