Healthcare Provider Details

I. General information

NPI: 1144894262
Provider Name (Legal Business Name): SARAH WELLS FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/13/2021
Last Update Date: 05/13/2021
Certification Date: 05/13/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

26317 WASHINGTON ST
NORTH DINWIDDIE VA
23803-2727
US

IV. Provider business mailing address

1790 WESTWOOD FARMS CT
MECHANICSVILLE VA
23111-6772
US

V. Phone/Fax

Practice location:
  • Phone: 804-524-7000
  • Fax:
Mailing address:
  • Phone: 804-512-7507
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number0024179053
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: