Healthcare Provider Details

I. General information

NPI: 1790203602
Provider Name (Legal Business Name): JAMES WELLS RN, MSN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/31/2017
Last Update Date: 08/31/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9040 JACKSON AVENUE
TACOMA WA
98431-5916
US

IV. Provider business mailing address

16312 44TH AVE E
TACOMA WA
98446-5914
US

V. Phone/Fax

Practice location:
  • Phone: 253-968-5117
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC0400X
TaxonomyCase Management Registered Nurse
License Number73468
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: