Healthcare Provider Details

I. General information

NPI: 1801641766
Provider Name (Legal Business Name): MS. BRIANNA KATHERINE WELLS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/23/2024
Last Update Date: 01/30/2025
Certification Date: 01/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

583 N QUEEN STREET SUITE 200
LANCASTER PA
17603
US

IV. Provider business mailing address

620 INTERSTATE PKWY
BRADFORD PA
16701-2924
US

V. Phone/Fax

Practice location:
  • Phone: 717-393-1900
  • Fax: 717-553-5040
Mailing address:
  • Phone: 814-366-1202
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: