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General NPI Number Information
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NPI Number | 1639153505
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Entity Type | Individual
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Provider Name | MELISSA RAE WELLS NP
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Gender | Female
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Dates
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Enumeration Date | 12/02/2005
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Last Update Date | 12/06/2013
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Provider Practice Location Address
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Address Line | 1210 SAINT ANDREWS
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City | HIGHLAND
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State | MI
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Zip | 48357-4758
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Country | US
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Telephone | 571-251-3671
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Fax |
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Provider Business Mailing Address
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Address Line | 1210 SAINT ANDREWS
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City | HIGHLAND
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State | MI
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Zip | 48357-4758
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Country | US
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Telephone | 571-251-3671
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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 | 3294402
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License Number State | FL
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