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General NPI Number Information
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NPI Number | 1154288488
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Entity Type | Individual
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Provider Name | JACQUELINE WELLS RN
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Gender | Female
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Dates
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Enumeration Date | 01/08/2026
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Last Update Date | 01/08/2026
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Provider Practice Location Address
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Address Line | 502 STEVENS AVE UNIT 1B
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City | PORTLAND
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State | ME
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Zip | 04103-2611
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Country | US
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Telephone | 207-894-4806
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Fax |
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Provider Business Mailing Address
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Address Line | 16 BENJAMIN WAY
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City | GORHAM
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State | ME
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Zip | 04038-2783
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Country | US
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Telephone | 518-209-1874
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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 | 163WC1500X
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Taxonomy Name | Community Health Registered Nurse
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License Number | RN74872
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License Number State | ME
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