Healthcare Provider Details

I. General information

NPI: 1255957320
Provider Name (Legal Business Name): CATHY ANN WELLS AGNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/24/2020
Last Update Date: 06/24/2020
Certification Date: 06/24/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

515 MAIN ST
OLEAN NY
14760-1598
US

IV. Provider business mailing address

10 GENESEE PKWY
CUBA NY
14727-1123
US

V. Phone/Fax

Practice location:
  • Phone: 716-701-1704
  • Fax:
Mailing address:
  • Phone: 716-307-7624
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberF309574-01
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: