Healthcare Provider Details

I. General information

NPI: 1669405809
Provider Name (Legal Business Name): DAWNA L WELLS PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/09/2006
Last Update Date: 10/31/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2900 12TH AVE N STE 160W
BILLINGS MT
59101-7506
US

IV. Provider business mailing address

PO BOX 30976
BILLINGS MT
59107-0976
US

V. Phone/Fax

Practice location:
  • Phone: 406-238-6290
  • Fax: 406-238-6961
Mailing address:
  • Phone: 406-238-6290
  • Fax: 406-238-6961

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number77
License Number StateMT
# 2
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number77
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: