=====================================================
General NPI Number Information
=====================================================
NPI Number | 1811968977
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | VERONICA LYNN WELLS RN CNS
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/27/2006
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4502 E 41 ST STE 2G12
-----------------------------------------------------
City | TULSA
-----------------------------------------------------
State | OK
-----------------------------------------------------
Zip | 74135
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 918-660-3617
-----------------------------------------------------
Fax | 918-660-3631
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 268838
-----------------------------------------------------
City | OKLAHOMA CITY
-----------------------------------------------------
State | OK
-----------------------------------------------------
Zip | 73126-8838
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 918-660-3632
-----------------------------------------------------
Fax | 918-660-3631
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 364S00000X
-----------------------------------------------------
Taxonomy Name | Clinical Nurse Specialist
-----------------------------------------------------
License Number | R0042762
-----------------------------------------------------
License Number State | OK
-----------------------------------------------------