Healthcare Provider Details

I. General information

NPI: 1861649923
Provider Name (Legal Business Name): MARY F WELLHONER LTD A NEVADA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/20/2008
Last Update Date: 04/11/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

645 SIERRA ROSE DR
RENO NV
89511-2366
US

IV. Provider business mailing address

645 SIERRA ROSE DR
RENO NV
89511-2366
US

V. Phone/Fax

Practice location:
  • Phone: 775-352-9355
  • Fax: 775-352-3575
Mailing address:
  • Phone: 775-352-9355
  • Fax: 775-352-3575

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License Number8741
License Number StateNV
# 2
Primary TaxonomyN
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. MARY F WELLHONER
Title or Position: OWNER
Credential: M.D.
Phone: 775-352-9355