Healthcare Provider Details

I. General information

NPI: 1225317795
Provider Name (Legal Business Name): ANN MARIE WELLS FNP-BC, APNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/15/2011
Last Update Date: 09/24/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

525 AIRPORT DR.
ONEIDA WI
54155
US

IV. Provider business mailing address

PO BOX 365
ONEIDA WI
54155
US

V. Phone/Fax

Practice location:
  • Phone: 920-869-2711
  • Fax: 920-869-1077
Mailing address:
  • Phone: 920-869-2711
  • Fax: 920-869-1077

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number4505-33
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: