Healthcare Provider Details

I. General information

NPI: 1417430588
Provider Name (Legal Business Name): MONICA ANNETTE WELLS FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MONICA ANNETTE TOSTON

II. Dates (important events)

Enumeration Date: 09/13/2018
Last Update Date: 11/17/2020
Certification Date: 11/17/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

323 S MINNESOTA ST
CROOKSTON MN
56716-1601
US

IV. Provider business mailing address

323 S MINNESOTA ST
CROOKSTON MN
56716-1601
US

V. Phone/Fax

Practice location:
  • Phone: 218-281-9553
  • Fax: 218-281-9393
Mailing address:
  • Phone: 218-281-9293
  • Fax: 218-207-0489

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number6279
License Number StateMN
# 2
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number6279
License Number StateMN
# 3
Primary TaxonomyN
Taxonomy Code163WX0800X
TaxonomyOrthopedic Registered Nurse
License Number1642988
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: