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General NPI Number Information
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NPI Number | 1104991777
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Entity Type | Individual
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Provider Name | RENE L WELLS PA-C
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Gender | Female
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Dates
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Enumeration Date | 11/21/2006
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Last Update Date | 04/06/2011
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Provider Practice Location Address
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Address Line | 90 BEAVER DR BLDG C
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City | DU BOIS
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State | PA
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Zip | 15801-2440
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Country | US
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Telephone | 814-317-2273
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Fax |
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Provider Business Mailing Address
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Address Line | 90 BEAVER DR BLDG C
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City | DU BOIS
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State | PA
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Zip | 15801-2440
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Country | US
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Telephone | 814-317-2273
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | OA002592
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License Number State | PA
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Taxonomy #2
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | MA051791
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License Number State | PA
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