Healthcare Provider Details

I. General information

NPI: 1730359027
Provider Name (Legal Business Name): JANE A WELLMAN ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/03/2008
Last Update Date: 01/14/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12221N MO PAC EXPY
AUSTIN TX
78758-2401
US

IV. Provider business mailing address

12221N MO PAC EXPY
AUSTIN TX
78758-2401
US

V. Phone/Fax

Practice location:
  • Phone: 512-901-4009
  • Fax: 512-901-3909
Mailing address:
  • Phone: 512-901-4009
  • Fax: 512-901-3909

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAP126378
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: