Healthcare Provider Details

I. General information

NPI: 1528594900
Provider Name (Legal Business Name): WELLS ACUPUNCTURE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/04/2017
Last Update Date: 05/04/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

325 PAGE ROAD SUITE 204
PINEHURST NC
28374
US

IV. Provider business mailing address

17 STRATHAVEN DR
PINEHURST NC
28374-9779
US

V. Phone/Fax

Practice location:
  • Phone: 910-986-2612
  • Fax:
Mailing address:
  • Phone: 910-986-2612
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberLAC908
License Number StateNC

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier101316819
Identifier TypeOTHER
Identifier State
Identifier IssuerNPI FOR INDIVIDUAL

VIII. Authorized Official

Name: KATHRYN WELLS
Title or Position: OWNER
Credential:
Phone: 910-986-2612