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General NPI Number Information
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NPI Number | 1629576152
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Entity Type | Individual
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Provider Name | DINA MARIE WELLS APRN
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Gender | Female
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Dates
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Enumeration Date | 01/30/2018
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Last Update Date | 01/30/2018
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Provider Practice Location Address
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Address Line | 3400 SE MACY RD STE 18
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City | BENTONVILLE
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State | AR
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Zip | 72712-7844
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Country | US
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Telephone | 479-845-0880
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Fax | 479-286-0061
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Provider Business Mailing Address
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Address Line | 3400 SE MACY RD STE 18
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City | BENTONVILLE
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State | AR
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Zip | 72712-7844
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Country | US
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Telephone | 479-845-0880
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Fax | 479-286-0061
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | A005113
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License Number State | AR
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