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General NPI Number Information
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NPI Number | 1629884176
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Entity Type | Individual
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Provider Name | ANTOINISHA WELLS CRNP
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Gender | Female
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Dates
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Enumeration Date | 12/09/2024
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Last Update Date | 12/09/2024
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Provider Practice Location Address
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Address Line | 3400 SPRUCE ST
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City | PHILADELPHIA
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State | PA
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Zip | 19104-4238
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Country | US
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Telephone | 215-316-5151
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Fax |
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Provider Business Mailing Address
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Address Line | 6121 WAYNE AVE APT 1
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City | PHILADELPHIA
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State | PA
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Zip | 19144-6121
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Country | US
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Telephone | 267-701-9034
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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 | 363LW0102X
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Taxonomy Name | Women's Health Nurse Practitioner
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License Number | SP030696
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License Number State | PA
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